NETWORK CREDENTIALING AND DEVELOPMENT Clause Samples

NETWORK CREDENTIALING AND DEVELOPMENT. APS will perform certain credentialing and recredentialing functions, on Priority behalf, for all MHSA Providers and will assist Priority in the development of provider contracts and provider profiling. (a) Priority delegates to APS certain functions related to the credentialing of all professional MHSA Providers, as described and delineated in Attachment D to this Agreement and as set forth in the separate Letter of Agreement for Delegated Credentialing by and between the parties. APS' credentialing activities will comply with the applicable requirements of the National Committee for Quality Assurance ("NCQA") as more specifically addressed in Section 7.4. (b) APS will assist Priority in the institution of its network management tool known as the "APS Core Group concept," including use of automated authorization protocols and case rates where applicable. (c) APS will assist Priority in developing a network plan, which will ensure a network of the proper size, scope and levels of care to adequately service Enrollees. (d) APS will assist Priority in contracting with MHSA Providers to provide MHSA Services and UM Services to Enrollees adequate to assure that 90% of all Enrollees residing within the Service Area are within 30 miles or 30 minutes of a MHSA Provider. Priority will notify APS in writing at least 120 days prior to any modification to the Service Area as it exists on the date of this Agreement. If Priority expands the Service Area; APS will assist Priority in arranging for MHSA Providers in such expanded Service Area. (e) Upon written request by Priority, APS will provide Priority a copy of APS' then current generic provider agreements and will provide Priority such other assistance with provider contracting as Priority reasonably requests.