Common use of Provider Qualifications and Performance Clause in Contracts

Provider Qualifications and Performance. 2.7.2.1. Written Provider Protocols: The Contractor must have written protocols in the following areas: 2.7.2.1.1. Credentialing, re-credentialing, certification, and performance appraisal processes that demonstrate that all members of the Provider Network maintain current knowledge, ability, and expertise in the service or specialty in which they practice. Providers must meet board certification, continuing education, and other requirements, as appropriate. The Contractor shall demonstrate to CMS and EOHHS, by reporting annually that all providers within the Contractor‘s Provider/Pharmacy Network are credentialed according to Section 2.8.3 of the Contract. The protocol must also include: Enrollee Complaints and Appeals; results of quality reviews; utilization management information; and Enrollee surveys; 2.7.2.1. 2. Practice guidelines, in accordance with 42 C.F.R. § 438.236 and 42 C.F.R. § 422.202(b);

Provider Qualifications and Performance. 2.7.2.1. Written Provider Protocols: The Contractor must have written protocols in the following areas: 2.7.2.1.1. Credentialing, re-credentialing, certification, and performance appraisal processes that demonstrate that all members of the Provider Network maintain current knowledge, ability, and expertise in the service or specialty in which they practice. Providers must meet board certification, continuing education, and other requirements, as appropriate. The Contractor shall demonstrate to CMS and EOHHS, by reporting annually that all providers within the Contractor‘s Contractor’s Provider/Pharmacy Network are credentialed according to Section 2.8.3 of the Contract. The protocol must also include: Enrollee Complaints and Appeals; results of quality reviews; utilization management information; and Enrollee surveys; 2.7.2.1. 2. Practice guidelines, in accordance with 42 C.F.R. § 438.236 and 42 C.F.R. § 422.202(b);

Provider Qualifications and Performance. 2.7.2.1. Written Provider Protocols: The Contractor must have written protocols in the following areas: 2.7.2.1.1. Credentialing, re-credentialing, certification, and performance appraisal processes that demonstrate that all members of the Provider Network maintain current knowledge, ability, and expertise in the service or specialty in which they practice. Providers must meet board certification, continuing education, and other requirements, as appropriate. The Contractor shall demonstrate to CMS and EOHHS, by reporting annually that all providers within the Contractor‘s Contractor’s Provider/Pharmacy Network are credentialed according to Section 2.8.3 of the Contract. The protocol must also include: Enrollee Complaints and Appeals; results of quality reviews; utilization management information; and Enrollee surveys; 2.7.2.1. 2. Practice guidelines, in accordance with 42 C.F.R. § 438.236 and 42 C.F.R. § 422.202(b);