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.
Appears in 2 contracts
Samples: Contract for Administrative Services Organization for Specialty Mental Health and Drug Medi Cal Substance Abuse Services, Contract for Administrative Services Organization for Specialty Mental Health and Drug Medi Cal Substance Abuse Services
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 CONTRACTORXXXXXXXXXX’s Provider Network and the reason for the denial upon request.
Appears in 2 contracts
Samples: Contract for Administrative Services Organization for Specialty Mental Health and Drug Medi Cal Substance Abuse Services, Contract for Administrative Services Organization for Specialty Mental Health and Drug Medi Cal Substance Abuse Services
