Common use of Credentialing and Recredentialing Criteria Clause in Contracts

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUD; • History of loss of license; • Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUD; •  History of loss of license; •  Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board Board, and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, information and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUD; • History of loss of license; • Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 455.106; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-post- graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 7 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUD; • History of loss of license; • Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board Board, and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, information and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract. All providers must notify BMS and the MCO no less than thirty (30) calendar days in advance when they relocate or open a new office; the MCO shall update the provider’s records within thirty (30) calendar days of receipt of notification from BMS of the changes.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUDsubstance abuse; • History of loss of license; • Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) DEA or Controlled Dangerous Substance (CDS) CDS certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) DEA/BNDD number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUDsubstance abuse; • History of loss of license; • Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) DEA or Controlled Dangerous Substance (CDS) CDS certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) DEA/BNDD number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contractcontract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUD; • History of loss of license; • Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 7 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract. All providers must notify the MCO no less than thirty (30) calendar days in advance when they relocate or open a new office; the MCO shall update the provider’s records within thirty (30) calendar days of receipt of notification from BMS of the changes.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUDsubstance abuse; •  History of loss of license; •  Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) DEA or Controlled Dangerous Substance (CDS) CDS certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) DEA/BNDD number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contractcontract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUDsubstance abuse; • History of loss of license; • Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 455.106; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUD; •  History of loss of license; •  Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 7 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract. All providers must notify the MCO no less than thirty (30) calendar days in advance when they relocate or open a new office; the MCO shall update the provider’s records within thirty (30) calendar days of receipt of notification from BMS of the changes.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUD; •  History of loss of license; •  Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board Board, and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, information and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract. All providers must notify BMS and the MCO no less than thirty (30) calendar days in advance when they relocate or open a new office; the MCO shall update the provider’s records within thirty (30) calendar days of receipt of notification from BMS of the changes.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUDsubstance abuse; •  History of loss of license; •  Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 455.106; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUD; • History of loss of license; • Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board Board, and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia C.S.R. §114-53-6 and 42 CFR §455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUD; •  History of loss of license; •  Felony convictions as required by West Virginia C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 §455.106; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension suspension, or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR §455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) or Controlled Dangerous Substance (CDS) certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 7 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia W. Va. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: • Any physical or mental health problems that may affect current ability to provide health care; • Any history of chemical dependency/SUDsubstance abuse; • History of loss of license; • Felony convictions as required by West Virginia W. Va. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; • History of loss or limitation of privileges or disciplinary activity; • History of debarment, suspension or exclusion from any Federal or State healthcare programs; and • An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: • The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; • The provider holds a current valid license to practice; • Valid Drug Enforcement Administration (DEA) DEA or Controlled Dangerous Substance (CDS) CDS certificate, as applicable; • Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; • Board certification or eligibility, or specialized training as appropriate; • Work history; • Professional liability claims history; • Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); • The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; • Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) DEA/BNDD number; • Any curtailment or suspension of medical staff privileges (other than for incomplete records); • Any censure by the State or County Medical Association; and • Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.

Credentialing and Recredentialing Criteria. The credentialing process must comply with West Virginia X. Xx. C.S.R. §114-53-6 and 42 CFR 455, Subpart B and at a minimum include a statement by the applicant regarding: •  Any physical or mental health problems that may affect current ability to provide health care; •  Any history of chemical dependency/SUDsubstance abuse; •  History of loss of license; •  Felony convictions as required by West Virginia X. Xx. C.S.R. §114-53-6.3 and other criminal convictions as required by 42 CFR 455.106 ; •  History of loss or limitation of privileges or disciplinary activity; •  History of debarment, suspension or exclusion from any Federal or State healthcare programs; and •  An attestation to correctness/completeness of the application. During the initial credentialing process, the MCO must verify: •  The identity and the exclusion status of provider and any person with an ownership or control interest or who is an agent or managing employee of the provider through checks of Federal databases as described in 42 CFR 455.436; •  The provider holds a current valid license to practice; •  Valid Drug Enforcement Administration (DEA) DEA or Controlled Dangerous Substance (CDS) CDS certificate, as applicable; •  Graduation from medical school and completion of a residency, or other post-graduate training, as applicable; •  Board certification or eligibility, or specialized training as appropriate; •  Work history; •  Professional liability claims history; •  Good standing of clinical privileges at the hospital designated by the provider as the primary admitting facility (this requirement may be waived for practices which do not have or do not need access to hospitals); •  The provider holds current, adequate malpractice insurance with minimum coverage requirements of $1 million per individual episode and $1 million in the aggregate; •  Any revocation or suspension of a state license or DEA/ Bureau of Narcotics and Dangerous Drugs (BNDD) DEA/BNDD number; •  Any curtailment or suspension of medical staff privileges (other than for incomplete records); •  Any censure by the State or County Medical Association; and •  Any enrollee complaints. In addition, the MCO must request information on the provider from the National Practitioner Data Bank and appropriate state licensing boards such as the Board of Medicine, Chiropractic Board, Osteopathic Board and/or Dental Board. During the recredentialing process, the MCO must re-verify and update all of the above information, and consider performance indicators such as those collected through the quality assurance and performance improvement program (see Article III, Section 6 of this contract), the utilization management system, the grievance system, enrollee satisfaction surveys, enrollee complaints, and other activities of the MCO. All contracted providers must meet the credentialing and recredentialing requirements listed in this Contract.