Common use of Non-Inclusion of Providers Clause in Contracts

Non-Inclusion of Providers. (A) The Contractor shall report to the Department when a Provider is denied Participating Provider status. Such denial can include when a Provider is denied admission to the Contractor’s provider panel, is removed from the Contractor’s panel, or voluntarily withdraws from the panel when the denial, removal, or withdrawal is due to a substantive issue. Substantive issues include violations of the Department of Occupational and Professional Licensing’s regulations, and allegations of Fraud, Waste or Abuse. (B) The Contractor shall electronically submit information relating to the non-inclusion of Providers to the Department within 30 calendar days of the non-inclusion action using the Department-specified form. (C) The Contractor shall not report non-inclusion of Providers when due to non-substantive issues. Non-substantive issues include instances where the provider fails to complete the credentialing process or the Contractor has sufficient network capacity.

Non-Inclusion of Providers. (A) The Contractor shall report to the Department when a Provider is denied Participating Network Provider status. Such denial can include when a Provider is denied admission to the Contractor’s provider panel, is removed from the Contractor’s panel, or voluntarily withdraws from the panel when the denial, removal, or withdrawal is due to a substantive issue. Substantive issues include violations of the Department of Occupational and Professional Licensing’s DOPL regulations, and allegations of Fraud, Waste or Abuse. (B) The Contractor shall electronically submit information relating to the non-non- inclusion of Providers to the Department within 30 calendar days of the non-non- inclusion action using the Department-specified form. (C) The Contractor shall not report non-inclusion of Providers when due to non-non- substantive issues. Non-substantive issues include instances where the provider Provider fails to complete the credentialing process or the Contractor has sufficient network capacity.

Non-Inclusion of Providers. (A) The Contractor shall report to the Department when a Provider is denied Participating Network Provider status. Such denial can include when a Provider is denied admission to the Contractor’s provider panel, is removed from the Contractor’s panel, or voluntarily withdraws from the panel when the denial, removal, or withdrawal is due to a substantive issue. Substantive issues include violations of the Department of Occupational and Professional LicensingDOPL’s regulations, and allegations of Fraud, Waste or Abuse. (B) The Contractor shall electronically submit information relating to the non-inclusion of Providers to the Department within 30 calendar days of the non-inclusion action using the Department-specified form. (C) The Contractor shall not report non-inclusion of Providers when due to non-substantive issues. Non-substantive issues include instances where the provider fails to complete the credentialing process or the Contractor has sufficient network capacity.

Non-Inclusion of Providers. (A) The Contractor shall report to the Department when a Provider is denied Participating Network Provider status. Such denial can include when a Provider is denied admission to the Contractor’s provider panel, is removed from the Contractor’s panel, or voluntarily withdraws from the panel when the denial, removal, or withdrawal is due to a substantive issue. Substantive issues include violations of the Department of Occupational and Professional Licensing’s regulations, and allegations of Fraud, Waste or Abuse. (B) The Contractor shall electronically submit information relating to the non-inclusion of Providers to the Department within 30 calendar days of the non-inclusion action using the Department-specified form. (C) The Contractor shall not report non-inclusion of Providers when due to non-substantive issues. Non-substantive issues include instances where the provider Provider fails to complete the credentialing process or the Contractor has sufficient network capacity.

Non-Inclusion of Providers. (A) The Contractor shall report to the Department when a Provider is denied Participating Network Provider status. Such denial can include when a Provider is denied admission to the Contractor’s provider panel, is removed from the Contractor’s panel, or voluntarily withdraws from the panel when the denial, removal, or withdrawal is due to a substantive issue. Substantive issues include violations of the Department of Occupational and Professional Licensing’s regulations, and allegations of Fraud, Waste or Abuse. (B) The Contractor shall electronically submit information relating to the non-inclusion of Providers to the Department within 30 calendar days of the non-inclusion action using the Department-specified form. (C) The Contractor shall not report non-inclusion of Providers when due to non-substantive issues. Non-substantive issues include instances where the provider fails to complete the credentialing process or the Contractor has sufficient network capacity.