Provider Credentialing and Qualifications Sample Clauses

Provider Credentialing and Qualifications. ‌ The Contractor must prepare, submit to the Division for approval, and follow a documented process for credentialing and recredentialing of Providers who have signed contracts or participation agreements with the Contractor, in accordance with 42 C.F.R. § 438.214 and Mississippi Department of Insurance Regulation 98-1. The Contractor shall maintain a Credentialing Committee and the Contractor’s Medical Director shall have overall responsibility for the committee’s activities. The Contractor’s credentialing and recredentialing policies and procedures must meet the requirements within 42 C.F.R.§438.12 and must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor may not employ or contract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. The Contractor shall use credentialing and recredentialing standards set forth by the National Committee for Quality Assurance (NCQA) and EQRO recommendations. The Contractor must follow the most current version of the credentialing organization’s credentialing requirements from year to year. The Contractor shall verify and certify to the Division that all Network Providers and any Out-of-network Providers to whom Members may be referred are properly licensed in accordance with all applicable State law and regulations, are eligible to participate in the Medicaid program, and have in effect appropriate policies of malpractice insurance as may be required by the Contractor and the Division. The Contractor must ensure that all Network Providers are enrolled with the State as Medicaid providers consistent with the provider disclosure, screening and enrollment requirements of 42 C.F.R. part 455, subparts B and E. This provision does not require the Network Provider to render services to fee for service beneficiaries. All Contractor Network Providers must also be enrolled in the Mississippi Medicaid program using the same National Provider Identifier (NPI) numbers. Contracted nurse practitioners acting at PCPs shall be held to the same requirements and standards as physicians acting at PCPs. The Contractor may execute Network Provider agreements pending the outcome of the process in §438.602 (b)(1) of up to one hundred and twenty (120) days, but must terminate a Network Provider immediately upon notification from the State that the Network Provider cann...
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Related to Provider Credentialing and Qualifications

  • Provider Credentialing Contractor shall perform, or may delegate activities related to, credentialing and re-credentialing Participating Providers in accordance with a process reviewed and approved by State Regulators.

  • Required Qualifications Not Applicable

  • Tenderers Eligibility and Qualifications 2.11.1Pursuant to paragraph 2.1. The tenderers shall furnish, as part of its tender, documents establishing the tenderers eligibility to tender and its qualifications to perform the Framework Agreement if its tender is accepted.

  • Organization and Qualification The Company and each of the Subsidiaries is an entity duly incorporated or otherwise organized, validly existing and in good standing under the laws of the jurisdiction of its incorporation or organization, with the requisite power and authority to own and use its properties and assets and to carry on its business as currently conducted. Neither the Company nor any Subsidiary is in violation nor default of any of the provisions of its respective certificate or articles of incorporation, bylaws or other organizational or charter documents. Each of the Company and the Subsidiaries is duly qualified to conduct business and is in good standing as a foreign corporation or other entity in each jurisdiction in which the nature of the business conducted or property owned by it makes such qualification necessary, except where the failure to be so qualified or in good standing, as the case may be, could not have or reasonably be expected to result in: (i) a material adverse effect on the legality, validity or enforceability of any Transaction Document, (ii) a material adverse effect on the results of operations, assets, business, prospects or condition (financial or otherwise) of the Company and the Subsidiaries, taken as a whole, or (iii) a material adverse effect on the Company’s ability to perform in any material respect on a timely basis its obligations under any Transaction Document (any of (i), (ii) or (iii), a “Material Adverse Effect”) and no Proceeding has been instituted in any such jurisdiction revoking, limiting or curtailing or seeking to revoke, limit or curtail such power and authority or qualification.

  • Organization, Good Standing and Qualification The Company is a corporation duly organized, validly existing, and in good standing under the laws of the State of Delaware and has all requisite corporate power and authority to carry on its business as now conducted. The Company is duly qualified to transact business and is in good standing in each jurisdiction in which the failure to so qualify would have a material adverse effect on its business or properties.

  • NMHS Governance, Safety and Quality Requirements 3.1 Participates in the maintenance of a safe work environment.

  • SMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment.

  • EMHS Governance, Safety and Quality Requirements 4.1 Participates in the maintenance of a safe work environment.

  • Personnel Qualifications Contractor shall assign properly qualified and experienced personnel to the program contemplated under this Agreement, and Contractor shall use reasonable efforts to retain such personnel on Customer’s program for the duration of such program.

  • Contractor Qualifications Contractor warrants that Contractor has the necessary licenses, experience and technical skills to provide services under this Contract.

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