Common use of Provider Selection Clause in Contracts

Provider Selection. A. The Contractor shall have written policies and procedures for selection and retention of providers. (42 C.F.R. § 438.214(a).) B. Contractor’s policies and procedures for selection and retention of providers must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (42 C.F.R. §§ 438.12(a)(2), 438.214(c).) C. In all subcontracts with network providers, the Contractor must follow the Department’s uniform credentialing and re-credentialing policy. The Contractor must follow a documented process for credentialing and re- credentialing of network providers. (42 C.F.R. §§ 438.12(a)(2), , 438.214(b).) D. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. (42 C.F.R. § 438.214(d).) E. The Contractor may not discriminate in the selection, reimbursement, or indemnification of any provider who is acting within the scope of his or her license or certification under applicable state law, solely on the basis of that license or certification. (42 C.F.R. § 438.12(a)(1).)

Provider Selection. A. The Contractor shall have written policies and procedures for selection and retention of providers. (42 C.F.R. § 438.214(a).) B. The Contractor’s policies and procedures for selection and retention of providers must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. (42 C.F.R. §§ 438.12(a)(2), 438.214(c).) C. In all subcontracts with network providers, the Contractor must follow the Department’s uniform credentialing and re-credentialing policy. The Contractor must follow a documented process for credentialing and re- credentialing of network providers. (42 C.F.R. §§ 438.12(a)(2), , 438.214(b).) D. The Contractor shall not employ or subcontract with providers excluded from participation in Federal health care programs under either section 1128 or section 1128A of the Act. (42 C.F.R. § 438.214(d).) E. The Contractor may not discriminate in the selection, reimbursement, or indemnification of any provider who is acting within the scope of his or her their license or certification under applicable state law, solely on the basis of that license or certification. (42 C.F.R. § 438.12(a)(1).)