General Provider Credentialing Sample Clauses

General Provider Credentialing. The Contractor shall: 2.8.3.1.1. Implement written policies and procedures that comply with the requirements of 42 C.F.R. §§ 422.504(i)(4)(iv) and 438.214(b) regarding the selection, retention and exclusion of providers and meet, at a minimum, the requirements below. The Contractor shall submit such policies and procedures annually to EOHHS, if amended, and shall demonstrate to EOHHS, by reporting annually that all providers within the Contractor‘s Provider Network are credentialed according to such policies and procedures. The Contractor shall: 2.8.3.1.1.1. Designate and describe the departments(s) and person(s) at the Contractor‘s organization who will be responsible for provider credentialing and re- credentialing; 2.8.3.1.1.2. Maintain appropriate, documented processes for the credentialing and re-credentialing of physician providers and all other licensed or certified providers who participate in the Contractor‘s Provider Network. At a minimum, the scope and structure of the processes shall be consistent with recognized managed care industry standards such as those provided by the National Committee for Quality Assurance (NCQA) and relevant State regulations, including regulations issued by the Board of Registration in Medicine (BORIM) at 243 CMR
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General Provider Credentialing. 2.9.3.1.1. The Contractor shall implement written policies and procedures that comply with the requirements of 42 C.F.R. §§ 422.504(i)(4)(iv) and 438.214(b) regarding the selection, retention and exclusion of providers and meet, at a minimum, the requirements below. 2.9.3.1.2. The Contractor shall submit such policies and procedures annually to DMAS, if amended, and shall demonstrate to DMAS, by reporting annually that all providers within the Contractor’s Provider Network are credentialed according to such policies and procedures. 2.9.3.1.3. The Contractor shall: 2.9.3.1.3.1. Designate and describe the department(s) and person(s) at the Contractor’s organization who will be responsible for provider credentialing and re-credentialing; 2.9.3.1.3.2. Maintain appropriate, documented processes for the credentialing and re-credentialing of licensed physician providers and all other licensed or certified providers who participate in the Contractor’s Provider Network to perform the services agreed to under this contract. At a minimum, the scope and structure of the processes shall be consistent with recognized managed care industry standards such as those provided by the NCQA and relevant state regulations, including regulations at 12 VAC 0-000-000; 2.9.3.1.3.3. Ensure that all providers are credentialed prior to becoming network providers and that a site visit is conducted as appropriate for initial credentialing; 2.9.3.1.3.4. Maintain a documented re-credentialing process which shall occur at least every three years (thirty six months) and shall take into consideration various forms of data including, but not limited to, grievances, results of quality reviews utilization management information, and Enrollee satisfaction surveys; 2.9.3.1.3.5. The Contractor’s standards for licensure and certification shall be included in its participating Provider Network contracts with its network providers which must be secured by current subcontracts or employment contracts. 2.9.3.1.3.6. Upon notice from DMAS or CMS, not authorize any providers terminated or suspended from participation in the Virginia Medicaid Program, Medicare or from another state’s Medicaid program, to treat Enrollees and shall deny payment to such providers for services provided. In addition: 2.9.3.1.3.6.1. The Contractor shall comply with requirements detailed at 42 C.F.R. § 455.436, requiring the Contractor to, at a minimum, check the Department of Health Professions website at least twice per month fo...

Related to General Provider Credentialing

  • File Management and Record Retention relating to CRF Eligible Persons or Households Grantee must maintain a separate file for every applicant, Eligible Person, or Household, regardless of whether the request was approved or denied. a. Contents of File: Each file must contain sufficient and legible documentation. Documents must be secured within the file and must be organized systematically.

  • Compliance with Contractor Employee Jury Service Ordinance Contractor shall comply with the County Ordinance with respect to provision of jury duty pay to employees and have and adhere to a written policy that provides that its employees shall receive from the Contractor, on an annual basis, no less than five days of regular pay for actual jury service in San Mateo County. The policy may provide that employees deposit any fees received for such jury service with the Contractor or that the Contractor deduct from the employees’ regular pay the fees received for jury service.

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Performance and Compliance with Contracts and Credit and Collection Policy The Seller shall (and shall cause the Servicer to), at its expense, timely and fully perform and comply with all material provisions, covenants and other promises required to be observed by it under the Contracts related to the Receivables, and timely and fully comply in all material respects with the applicable Credit and Collection Policies with regard to each Receivable and the related Contract.

  • Scope of Services and Term Subject to the provisions for early termination as set forth herein, the Contractor agrees that it will perform the Services enumerated in the scope of services attached hereto as Exhibit A and incorporated herein by reference (the “Scope of Services”) for a term of five years (5) beginning , 2023 through , 2028 (the “Term”). The Authority in its sole discretion may extend the Agreement for two (2) additional one-year periods, for a potential maximum term of *** (**) years. The Authority will provide any such renewal notice in writing at least thirty (30) days prior to expiration of the Agreement. The maximum payment for the Term is set forth in Section II(a). All work shall be diligently performed by the Contractor in an economical, expeditious and professional manner.

  • Customer Service, Dispute Resolution If you have a question about your XOOM charges or service you may contact XOOM directly by calling 0-000-000-0000 Monday – Friday 8 (eight) a.m. to 11 (eleven)p.m.

  • Orientation and In-Service Program The Hospital recognizes the need for a Hospital Orientation Program of such duration as it may deem appropriate taking into consideration the needs of the Hospital and the nurses involved.

  • Provider Directory a. The Contractor shall make available in electronic form and, upon request, in paper form, the following information about its network providers: i. The provider’s name as well as any group affiliation; ii. Street address(es); iii. Telephone number(s); iv. Website URL, as appropriate; v. Specialty, as appropriate; vi. Whether the provider will accept new beneficiaries; vii. The provider’s cultural and linguistic capabilities, including languages (including American Sign Language) offered by the provider or a skilled medical interpreter at the provider’s office, and whether the provider has completed cultural competence training; and viii. Whether the provider’s office/facility has accommodations for people with physical disabilities, including offices, exam room(s) and equipment. b. The Contractor shall include the following provider types covered under this Agreement in the provider directory: i. Physicians, including specialists ii. Hospitals

  • Coordination, Oversight and Monitoring of Service Providers As set forth in the Administrative Services Agreement between the Fund and CRMC, CRMC shall coordinate, monitor and oversee the activities performed by the Service Providers with which AFS contracts. AFS shall monitor Service Providers’ provision of services including the delivery of Customer account statements and all Fund-related material, including summary prospectuses and/or prospectuses, shareholder reports, and proxies.

  • – ORIENTATION AND IN SERVICE 20.01 An orientation and in service program will be provided to all employees. These programs shall be reviewed and discussed from time to time by members of the Union-Management Committee. 20.02 A newly employed employee shall not be placed in charge, until she has been fully oriented to the home. 20.03 The following minimums shall be observed in the orientation/familiarization of a newly hired employee: (a) She is to be familiarized with the physical aspects of the building, the applicable policies and procedures of the Employer, and the daily routine of employees in the Home. (b) The period of orientation/familiarization shall be for a minimum of five (5) days or such greater period that the Employer deems necessary. (c) She shall be an additional employee to the usual staffing pattern. (d) The employee or employees involved in the orientation/familiarization will confirm that it has been completed, and this will be noted on the newly hired employee's personnel file, which will be reviewed with such employee, and the employee shall also be able to comment. (e) The employee may request up to three (3) additional days of paid orientation. When making her request, the employee will specify her learning needs and discuss with the Director of Care the development of the orientation learning plan. This request will not be unreasonably denied. (f) Notwithstanding the above, orientation/familiarization when an employee is transferred to a new unit/shift will be provided as required. (g) The Employer may, at its discretion, provide orientation in other circumstances. 20.04 Both the Employer and the Union recognize the joint responsibility and commitment to provide, and participate in, in-service education. The Union supports the principle of its members' responsibility for their own professional development and the Employer will endeavour to provide programmes related to the requirements of the Home. Programmes will be publicized and related material will be made readily accessible to staff in a timely manner. Any problems in accessing this information will be reported to the Union- Management Committee for resolution. (a) When an employee is required by the Employer to attend any in-service program or e-learning within the Home during her or his regularly scheduled working hours the employee shall suffer no loss of regular pay. (b) When an employee is required by the Employer to prepare for in service or to attend meetings, in service and other work related functions outside her regularly scheduled working hours, and the employee does attend same, she shall be paid for all time spent on such attendance at her regular straight time hourly rate of pay or at the employee's option, she shall receive equivalent time off. When an employee is required by the Employer to complete an e-learning programme outside her regularly scheduled working hours, she shall be paid for all time spent completing such learning at her regular straight time hourly rate of pay or at the employee's option, she shall receive equivalent time off. Part-time employees will be credited with seniority and service for all such hours paid as provided above while in attendance at in-services, meetings, and completing e-learning. (c) The Employer will endeavour where practical to schedule in-services at times which will facilitate the attendance of employees working outside the day shift. 20.06 When required by a certifying body to update an employee's qualifications, except where this matter is covered by another provision of the collective agreement, the Employer shall grant leave of absence without pay which shall include the time required to write any examinations. 20.07 The Employer undertakes to notify the Union in advance, so far as practicable, of any technological changes which the Employer has decided to introduce which will significantly change the employment status of the employee(s) within the bargaining unit. The Employer agrees to discuss with the Union the effect of such technological changes on the employment status of the employee(s) and to consider practical ways and means of minimizing the adverse effect, if any, on the employee(s) concerned. Employees who are subject to layoff due to technological change will then be given notice of such layoff at the earliest reasonable time and in keeping with the requirements of the applicable legislation and the provisions of Article 9.11 to

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