Re-credentialing. The Provider must reapply for continued participation status once every two (2) years from the initial approval date. All required re-credentialing documents must be submitted to the Credentialing Contracted Agent before the day the current approval expires. Failure to submit all required re-credentialing documents will result in termination of credentialed status. The Contracted Agent will send a Termination Notice if the Provider fails to comply with this regulation. The Provider is eligible to apply for re-credentialing after 6 (six) months from the day the Termination Notice was sent. The Provider is not allowed to provide any credentialed services for 6 (six) months or at any time when the Provider is not credentialed. In addition, Staff must remain in compliance relating to all required materials (including but not limited to: background checks, motor vehicle license, motor vehicle insurance, first aid and CPR certification, mandated reporter training, staff photo) Should the provider fail to comply with these requirements for continued participation status, the staff is no longer allowed to provide services as an approved provider and will be terminated and remain ineligible to reapply for a period of six (6) months.
Re-credentialing a. CONTRACTOR shall update, verify and review all pertinent provider credentialing information and qualifications, and assess the provider’s performance over the previous three (3) years.
b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, clinical privileges, training, experience, current competence, or health status that may affect the provider’s ability to perform the services he or she is providing to members.
c. In order to determine whether to re-approve the provider’s participation in CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall be provided to ADMINISTRATOR upon request.
d. CONTRACTOR shall provide to COUNTY the names of providers denied participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.
Re-credentialing. 7 a. CONTRACTOR shall update, verify and review all pertinent provider credentialing 8 information and qualifications, and assess the provider’s performance over the previous three (3) years.
9 b. CONTRACTOR shall identify and evaluate any changes in the provider’s licensure, 10 clinical privileges, training, experience, current competence, or health status that may affect the 11 provider’s ability to perform the services he or she is providing to members.
12 c. In order to determine whether to re-approve the provider’s participation in 13 CONTRACTOR’s network, CONTRACTOR shall, in addition to updating credentialing information, 14 examine the provider’s clinical competence, examine QI, review patient complaints, and conduct site 15 visits when appropriate, in accordance with CONTRACTOR’s site audit policy, a copy of which shall 16 be provided to ADMINISTRATOR upon request.
17 d. CONTRACTOR shall provide to COUNTY the names of providers denied 18 participation in CONTRACTOR’s Provider Network and the reason for the denial upon request.
Re-credentialing. (1) The SERVICE PROVIDER conducts re-credentialing at least every two years, or sooner, as circumstances may require.
(2) The SERVICE PROVIDER’s re-credentialing policies include requirements for:
a. An update of the information obtained during the initial credentialing; and
b. A review of: • It and its staffs compliance with credentialing requirements; • Quality issues; and • Concerns which include grievances (complaints) and appeals information.
Re-credentialing. For purposes of Re-Credentialing, RHS shall consider quality performance, member satisfaction, compliance with RHS administrative procedures, utilization performance and practice patterns and attitudes as they relate to managed care practices.
Re-credentialing. Provider shall cooperate with the re-evaluation of their credentials at such intervals, as DentaQuest shall determine, but not more frequently than every three years. Such evaluation may take into account a review of Provider's past performance and practice patterns, and a review of dental records and evaluations pertaining to Provider's participation in the delivery of dental care.
Re-credentialing. The process for periodic re-credentialing will include the following:
(1) The Contractor shall complete the procedure for re-credentialing at least every three (3) years.
(2) The Contractor shall verify the current licensure of the subcontractor on an annual basis or as required by licensure.
(3) The Contractor shall verify Medicare and Medicaid exclusions on the subcontractor on the HHS Office of the Inspector General’s website on an annual basis.
(4) The Contractor shall develop and implement a mechanism for identifying quality deficiencies that result in the Contractor’s restriction, suspension, termination, or sanctioning of a subcontractor, including reviewing AHCA’s Florida Health Finder website.
Re-credentialing. The Provider must reapply for continued participation status once every two years from the initial approval date. The Credentialing Contracted Agent will collect up-to-date information on all required credentialing documents. Failure to comply with this regulation will delay the Re-Credentialing approval for up-to-sixty (60) days.
Re-credentialing. Contractor re-credentialing is performed at minimum every 36 months or as indicated by SBHASO.
Re-credentialing. The CONTRACTOR shall formally re-credential its network providers at least every three years.
