Common use of General Provider Credentialing Clause in Contracts

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

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 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 Contractor’s organization who will be responsible for provider credentialing and re- 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 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