PROVIDER ENGAGEMENT. The Contractor shall establish and maintain a formal provider engagement function, which shall include recruitment and retention of providers along with ongoing troubleshooting and education for contracted providers. The Contractor must give written notice of the reason for its decision when it declines to include an individual or groups of providers in its provider network. In all contracts with network providers, the Contractor must use a documented process and follow NCQA’s uniform credentialing and re- credentialing policy that addresses the health care services the provider is licensed to provide including acute, primary, behavioral, and substance use disorder. In all contracts with network providers, the Contractor’s provider selection policies and procedures must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall develop and submit annually, a plan outlining its efforts in provider engagement to include: recruitment, retention, education, training, and communication. In an effort to ensure ongoing improvement of provider relations the Contractor shall also conduct a survey to assess provider satisfaction, including at a minimum: satisfaction with enrollment, communication, education, complaint resolution, claims processing, claims reimbursement, care coordination, and utilization management. The Contractor agrees to alter and or update the survey as requested by the Department. The Contractor shall must receive approval by DMAS prior to submitting any communications to their provider network that includes information Federal and State law, regulation or policy regarding the Medicaid or Children’s Health Insurance Programs.
PROVIDER ENGAGEMENT. The Contractor shall establish and maintain a formal provider engagement function, which shall include recruitment and retention of providers along with ongoing troubleshooting and education for contracted providers. The Contractor must give written notice of the reason for its decision when it declines to include an individual or groups of providers in its provider network. In all contracts with network providers, the Contractor must use a documented process and follow NCQA’s uniform credentialing and re-credentialing policy that addresses the health care services the provider is licensed to provide including acute care, primary care, behavioral health services, and substance use disorder. In all provider network contracts, the Contractor’s provider selection policies and procedures must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. Annually, the Contractor shall develop and submit a plan outlining its efforts in provider engagement. At a minimum, the plan should include recruitment, retention, education, training, and communication. In an effort to ensure ongoing improvements in provider relations, the Contractor shall also conduct an annual survey to assess provider satisfaction, including at a minimum: satisfaction with enrollment, communication, education, complaint resolution, claims processing and reimbursement, care coordination, and utilization management. The Contractor agrees to alter and or update the survey as requested by the Department. The Contractor must receive approval by DMAS prior to providing any communication to their provider network that includes information pertaining to Federal and State laws, regulations or policies regarding the Medicaid or Children’s Health Insurance Programs.
PROVIDER ENGAGEMENT. Embold engages regularly with clinical and data experts in maintaining the most relevant set of measurements to ensure the most impactful measurement against validated evidence. Embold also maintains transparency within the provider community through Individual Provider Reports. Upon mutual agreement of Embold and the Employer, Embold may engage with one or more health system to ensure their providers may efficiently be educated on the value that Embold offers to both the employer and provider community. In markets where Embold determines sufficient ability to influence provider behavior at a health system level, Embold will at its own discretion proactively engage major health systems on behalf of the Employer and other clients of the Embold with the intent to improve quality of care across the health system. Proactive engagement within major health systems includes but is not limited to evaluation of health system quality, detailed scoring of providers on the health administrators, and quality experts within the health system and community.
PROVIDER ENGAGEMENT. An important measure for the quality of provision is the extent to which key professional or verification bodies endorse the programmes offered. As one of the main sources of information for provision delivered to the lifelong learning workforce is the HESA student record, and because the programme title field used to identify programmes rarely matches the name known to the professional bodies, many HEIs were approached to verify that this mapping was accurate. A sample of 41 HEIs was approached, selected where there were perceived difficulties in identifying endorsed provision in the HESA student record, with 18 responses in total: • 35 were approached in England, with 14 responding with verified or amended data • Two were approached in Northern Ireland, with both responding with verified or amended data • One was approached in Scotland, with no response • Three were approached in Wales, with two responding with verified or amended data. This process ensures a higher quality of information, from which inferences on the quality of provision are to be based.
