Credentialing Program Structure Sample Clauses

Credentialing Program Structure. The National Credentials Committee, composed of the Anthem Enterprise’s Medical Directors, the Medical Director of Medical Policy and Credentialing, and chaired by the VP Medical Policy, Technology & Credentialing, shall establish policies and procedures for the credentialing, recredentialing and ongoing monitoring oversight of network Practitioners and Health Delivery Organizations. In addition to providing the framework for credentialing and recredentialing functions, these policies will address the delegation of credentialing related activities and appeals mechanisms. Policies will be in compliance with relevant federal law as well as regulatory and accrediting bodies and will make allowance for state law when applicable. Policies will be reviewed at least annually, and revised as necessary. Policies established by the National Credentials Committee will be presented to the Company Credentials Committee for input and review. At the discretion of the chair, Company Medical Directors or other interested parties may present issues or concerns regarding credentialing policy issues to the National Credentials Committee. The Company shall establish a Credentials Committee to perform credentialing review for Practitioners and HDOs and render determinations. The Company Credentials Committee shall follow the policies and procedures set forth in the National Credentialing Policy.
Sample 1
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Related to Credentialing Program Structure

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