Credentialing and Recredentialing. Contractor shall develop and maintain written policies and procedures that include initial credentialing, recredentialing, recertification, and reappointment of physicians including PCPs and specialists in accordance with the DHCS Policy Letter 02-03, check to see if a provider is suspended or excluded suspended, excluded, or otherwise ineligible because of a sanction to receive, directly or indirectly, reimbursement from the Medi- Cal program pursuant to WIC Section 14043.61 and 42 C.F.R. § 455.436;, and adhere to managed care standards at 42 C.F.R. § 422.204. Contractor shall ensure those policies and procedures are reviewed and approved by the governing body, or designee. Contractor shall ensure that the responsibility for recommendations regarding credentialing decisions will rest with a credentialing committee or other peer review body.
Credentialing and Recredentialing. We agree to assess and verify all credentialing Applications and recredentialing information and to notify the applicant of our decision within sixty (60) days of receipt of all required information.
Credentialing and Recredentialing. (1) The Health Plan shall be responsible for the credentialing and recredentialing of its Provider network. Hospital ancillary Providers are not required to be independently credentialed if those Providers only provide services to the Health Plan Enrollees through the Hospital.
Credentialing and Recredentialing. 2.1 By virtue of the PPO Agreement and this Addendum A, Ameritas hereby delegates to Dentist and Dentist agrees to perform the credentialing/ recredentialing functions for the Additional Providers in accordance with Ameritas’ credentialing or recredentialing requirements (“Ameritas Credentialing Policies”), as the same may be updated by Ameritas from time to time upon notice to Dentist. Notwithstanding such delegation, Ameritas retains the ultimate credentialing decision. Dentist shall maintain current and complete credentialing files for each of the Additional Providers as required by Ameritas Credentialing Policies. Dentist may further delegate all or any part of its credentialing responsibility to another party only with Ameritas’ prior written consent.
Credentialing and Recredentialing. Contractor shall develop and maintain written policies and procedures that include initial credentialing, recredentialing, recertification, and reappointment of physicians including Primary Care Physicians and specialists in accordance with the MMCD Policy Letter 02-03, Credentialing and Recredentialing. Contractor shall ensure those policies and procedures are reviewed and approved by the governing body, or designee. Contractor shall ensure that the responsibility for recommendations regarding credentialing decisions will rest with a credentialing committee or other peer review body.
Credentialing and Recredentialing. Contractor shall implement and maintain written policies and procedures concerning the initial credentialing, recredentialing, recertification, and reappointment of Network Providers, developed by the Department in accordance with 42 CFR 438.214 and APL 16-012, and including but not limited to: Primary Care Physicians (PCP); Specialists; Providers for acute, behavioral health, and substance use disorders; and MLTSS Providers as appropriate per the requirements in Exhibit A, Attachment 21, Managed Long Term Services and Supports, Provision 4, Provider Network. Contractor shall ensure those policies and procedures are reviewed and approved by the governing body, or designee. Contractor shall ensure that the responsibility for recommendations regarding credentialing decisions will rest with a credentialing committee or other peer review body.
Credentialing and Recredentialing. (See Attachment II, Exhibit 7)
Credentialing and Recredentialing. Contractor, or Subcontractor on behalf of Contractors, shall develop and maintain written policies and procedures that include initial credentialing, recredentialing, recertification, and reappointment of physicians including Primary Care Physicians (PCP).
Credentialing and Recredentialing. Provider represents and warrants that at all times during this Agreement, Provider and all Group Members of Provider shall be in compliance with the credentialing and recredentialing requirements of Lucet. Provider authorizes Lucet or designee to verify any and all credentialing information as well as licensure, accreditations, services and programs offered, specialties, levels of malpractice insurance and experience. Provider agrees to cooperate with a periodic re-evaluation of its credentials conducted by Xxxxx. Provider acknowledges and agrees that credentialing, appointment and re-appointment to Lucet’ Network is necessary for this Agreement to be effective. Notwithstanding anything contrary, the earliest Effective Date for this Agreement is the later of either: (i) the date of Lucet’ signature; or (ii) the date Lucet’ Credentialing Committee approves Provider’s or at least one Group Member’s appointment, or reappointment, to Lucet’s Network; or (iii) or other date as required by Payor. Group Member shall become a Provider under the Agreement effective upon the date of, but not prior to, the credentialing completion date assigned by Lucet, or other date required by Payor.
Credentialing and Recredentialing. Contractor shall develop, and maintain written policies and procedures that include initial credentialing, recredentialing, recertification, and reappointment of Physicians including Primary Care Physicians and specialists in accordance with the MMCD Policy Letter 02-03, Credentialing and Recredentialing. Contractor shall ensure those policies and procedures are reviewed and approved by the governing body, or designee. Contractor shall ensure that the responsibility for recommendations regarding credentialing decisions will rest with a credentialing committee or other peer review body. Xxxxxx Healthcare of California Partner Plan, Inc. 06-55498 Exhibit A, Attachment 4
