Provider Contracting and Re-credentialing. Third Thursday Provider Call (August 20, 2015) Gail Fowler, Network Development Administrator

Size: px
Start display at page:

Download "Provider Contracting and Re-credentialing. Third Thursday Provider Call (August 20, 2015) Gail Fowler, Network Development Administrator"

Transcription

1 Provider Contracting and Re-credentialing Third Thursday Provider Call (August 20, 2015) Gail Fowler, Network Development Administrator

2 New Provider Contracting - In the Louisiana Behavioral Health Partnership In light of the transition of the integrated specialty behavioral health services into Medicaid managed care system, Magellan discontinued contracting and credentialing new providers as of May 31, After May 31, 2015, new providers are being directed to the Bayou Health plans. Magellan will continue to re-credential existing network providers. 2 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

3 Credentialing and Re-credentialing Requirements for Participating Providers In order to be a contracted provider within the LBHP network, all providers must meet standard contracting requirements with Magellan Health in Louisiana. This includes all credentialing and recredentialing requirements for the LBHP network. 3 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

4 Adding New Service Locations and Levels of Care Friday, August 28, 2015 is the deadline for existing contracted/credentialed providers who are interested in adding an additional location or level of care to their contract. 4 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

5 New Independent Assessors (IA) New providers who are interested in becoming an IA will be accepted through Friday, August 28, Contracted/credentialed providers who are interested in becoming an IA will be accepted through Wednesday, September 30, Third Thursday Provider Call (8/20/15): Treatment Record Reviews

6 What You Need To Know About Re-credentialing LBHP network providers are required to re-credential every three years and many providers will need to re-credential during You can review the previous credentialing date on your provider contract to see if you should anticipate correspondence from Magellan during Annual recertification through LA - Office of Behavioral Health (OBH) is also a requirement of continued provider participation in the LBHP. 6 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

7 What You Need To Know About Re-credentialing (Continued) Current practice data is vital to facilitating your re-credentialing in a timely manner. You can make real-time updates to practice data at such as: address Office contacts Office locations Telephone numbers Business hours Staff rosters Ensuring your provider records are complete and up to date will prevent delays such as: Applications returned for invalid address Delays in phone calls, voice messages, and s due to out-of-date information Re-credentialing information is provided to the correct contact for your agency. 7 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

8 Re-credentialing Notifications When re-credentialing, please adhere closely to all timelines to ensure you remain an active provider with Magellan as the Statewide Management Organization for the LBHP. You will receive a notification letter and an application 180 days prior to your re-credentialing due date. If no response is received within 150 days of your re-credentialing date, a reminder letter will be sent. A Termination Pending letter will be sent if no application has been received 90 days prior to re-credentialing date. You will receive a Final Termination letter 2 months prior to recredentialing date if documents have not been received. 8 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

9 Application and Attachments Your application must be completed in its entirety. Required attachments must be provided: State Licenses including current licenses held in other states, State CDS license and Federal DEA Registration Curriculum Vitae Certificate(s) of Professional Liability Insurance History of Malpractice suits in past 5 years, regardless of whether judgments or settlements paid Explanation of any Yes Answer(s) from General Questions Section on page 8 Current Employer Identification Number (EIN) andw-9 Form or Federal Tax Deposit Coupon Education Certificate for Foreign Medical Graduates (ECFMG) (If applicable) Health Plan Agreement (If applicable) If your completed application and attachments are not received, your affiliation with the LBHP will be terminated and you will no longer receive referrals. 9 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

10 Confidentiality Statement for Educational Presentations By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment. 10 Third Thursday Provider Call (8/20/15): Treatment Record Reviews

This letter is to let you know that you are due for re-credentialing as a participating provider for AmeriHealth Caritas Louisiana of Louisiana.

This letter is to let you know that you are due for re-credentialing as a participating provider for AmeriHealth Caritas Louisiana of Louisiana. ATTN: AmeriHealth Caritas Louisiana Providers RE: Provider Re-Credentialing CAQH ID: Dear Credentialing Contact: This letter is to let you know that you are due for re-credentialing as a participating

More information

Adverse Outcome Reporting Requirements. July 19, 2016

Adverse Outcome Reporting Requirements. July 19, 2016 Adverse Outcome Reporting Requirements July 19, 2016 Magellan of Virginia (Magellan) serves as the contracted Behavioral Health Services Administrator for the Department of Medical Assistance Services

More information

This document describes the internal Harbor Health Plan's criteria for credentialing and recredentialing.

This document describes the internal Harbor Health Plan's criteria for credentialing and recredentialing. vc I. SCOPE: This document describes the internal 's criteria for credentialing and recredentialing. II. POLICY: 's criteria for credentialing and recredentialing will be compliant with legal and accreditation

More information

Discharge and Follow-Up Planning. Presented by the Clinical and Quality Team

Discharge and Follow-Up Planning. Presented by the Clinical and Quality Team Discharge and Follow-Up Planning Presented by the Clinical and Quality Team After today s training you will be able to: Identify and summarize important information about discharge planning Have adequate

More information

Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter

Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter Treatment Foster Care-Case Management (TFC-CM) TFC Overview provided by Clinical and Quality teams Quarter 1 2016 After today s training you will be able to: Determine DMAS Medical Necessity Criteria (MNC)

More information

SC Uniform Managed Care Provider Credentialing Application

SC Uniform Managed Care Provider Credentialing Application SC Uniform Managed Care Provider Credentialing Application I. PERSONAL INFORMATION Solo Practice Group Practice Name: Last First M.I. Suffix Degree Maiden and/or other name List W-9 name if different Place

More information

Please Note: Please send all documentation related to the credentialing portion of this documentation to:

Please Note: Please send all documentation related to the credentialing portion of this documentation to: Please ote: The application process is split into different actions. Please send all documentation related to the contracting portion of this documentation to: Fax to: (916)350-8860 Or email to: BSCproviderinfo@blueshieldca.com

More information

PRACTICE INFORMATION AND LETTER AGREEMENT FORM. COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747

PRACTICE INFORMATION AND LETTER AGREEMENT FORM. COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747 PRACTICE INFORMATION AND LETTER AGREEMENT FORM COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747 PERSONAL DATA Last Name First Name License Number Tax I.D. Number for

More information

VNSNY CHOICE PRACTITIONER CREDENTIALING APPLICATION

VNSNY CHOICE PRACTITIONER CREDENTIALING APPLICATION Attached please find an application for participation with VNSNY CHOICE. Upon completion, please forward this application to: VNSNY CHOICE Attn: Provider Relations Network Development 1250 Broadway - 11th

More information

Provider Rights. As a network provider, you have the right to:

Provider Rights. As a network provider, you have the right to: NETWORK CREDENTIALING AND SANCTIONS ValueOptions program for credentialing and recredentialing providers is designed to comply with national accrediting organization standards as well as local, state and

More information

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31

EFFECTIVE DATE: 10/04. SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 SUBJECT: Primary Care Nurse Practitioners SECTION: CREDENTIALING POLICY NUMBER: CR-31 EFFECTIVE DATE: 10/04 Applies to all products administered by the plan except when changed by contract Policy Statement:

More information

To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan

To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan To Apply for BlueCross BlueShield of South Carolina and BlueChoice HealthPlan 1. Complete the SC Uniform Managed Care Provider Credentialing Application. 2. Enclose copies of the following items: A. State

More information

I. PERSONAL INFORMATION. Degree and/or Title SS# . Non-physician Practitioner (Please specify )

I. PERSONAL INFORMATION. Degree and/or Title SS#  . Non-physician Practitioner (Please specify ) Pennsylvania Standard Application This form should be typed or legibly printed in black or blue ink. Please answer all questions completely and fully. If more space is needed than provided on this application,

More information

Practitioners may be recredentialed at any time, but in no circumstance longer than a 36 month period.

Practitioners may be recredentialed at any time, but in no circumstance longer than a 36 month period. SUBJECT: PRIMARY CARE AND SPECIALTY PHYSICIAN RECREDENTIALING SECTION: CREDENTIALING POLICY NUMBER: CR-02 EFFECTIVE DATE: 1/01 Applies to all products administered by the Plan except when changed by contract

More information

Credentialing Application

Credentialing Application Credentialing Application 1. NAME Last First MI Degree Gender 2. BIRTH, SOCIAL SECURITY & E-MAIL ADDRESS Date of Birth Social Security # E-Mail Address 3. PRACTICE, OFFICE & SPECIALTY INFORMATION 3.1 Please

More information

CRNA INITIAL CREDENTIALING APPLICATION

CRNA INITIAL CREDENTIALING APPLICATION CRNA INITIAL CREDENTIALING APPLICATION Revised 01/12 GENERAL INSTRUCTIONS LocumTenens.com CVO must credential all providers prior to placement into any practice location. All information requested in this

More information

Standardized. Credentialing Form To Be Used By Health Maintenance Organizations Licensed in the State of Missouri

Standardized. Credentialing Form To Be Used By Health Maintenance Organizations Licensed in the State of Missouri I. GENERAL INFORMATION Standardized Credentialing Form To Be Used By Health Maintenance Organizations Licensed in the State of Missouri COMPLETE EACH SECTION AS THOROUGHLY AS POSSIBLE. PLEASE TYPE OR PRINT

More information

Eye Medical Provider Practice Application

Eye Medical Provider Practice Application and subsidiaries Eye Medical Provider Practice Application How to Join the Avesis Network. Complete and sign the application Complete and sign the W-9 Complete and sign the Credential Verification Release

More information

SAMPLE - Medical Staff Credentialing and Initial Appointment Policy

SAMPLE - Medical Staff Credentialing and Initial Appointment Policy Subject: Medical Staff Credentialing and Initial Appointment Number: Effective Date: Supersedes SPP# Dated: Approved by: (signature) Distribution: Medical Staff, Credentialing Manual, Medical Staff Office

More information

ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Rural Health Clinic

ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Rural Health Clinic LOUISIANA Department of HEALTH and HOSPITALS ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Rural Health Clinic (Enrollment packet is subject to change without

More information

OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application)

OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application) OREGON PRACTITIONER CREDENTIALING APPLICATION (Not an Employment Application) Prior to completing this credentialing application, please read and observe the following: Healthcare Organizations may contract

More information

LIBERTY DENTAL PLAN. Provider Credentialing Application. (* Required Fields) *OFFICE PHONE #: ( ) EMERGENCY PHONE #: ( ) *FAX #: ( )

LIBERTY DENTAL PLAN. Provider Credentialing Application. (* Required Fields) *OFFICE PHONE #: ( ) EMERGENCY PHONE #: ( ) *FAX #: ( ) (Complete one application per Provider) (* Required Fields) Credentialing Information: Owner: Associate: *PROVIDER NAME: DDS DMD Other (specify) *DATE OF BIRTH: / / Gender: Male Female Owning Dentist Name:

More information

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process.

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process. PERSONAL IDENTIFICATION DATA Last Name: First: MI: Degree: Date of Birth: Social Security

More information

GENERAL INFORMATION. English Spanish Arabic Chinese French German Hmong Hindi Laotian Philippine Vietnamese Other

GENERAL INFORMATION. English Spanish Arabic Chinese French German Hmong Hindi Laotian Philippine Vietnamese Other **INCOMPLETE APPLICATIONS WILL DELAY THE CREDENTIALING PROCESS** 1. Please print or type ALL responses. 2. If you need additional space to complete a section, please attach additional sheets. 3. If you

More information

Staggered Roll Out Plans of Care Moving to a Fee for Service Sharon Weber

Staggered Roll Out Plans of Care Moving to a Fee for Service Sharon Weber Staggered Roll Out Plans of Care Moving to a Fee for Service 5-7-18 Sharon Weber Staggered Roll Out To transition to a fee for service rather then a bundled rate the POC s will need to be discharged and

More information

Provider Credentialing

Provider Credentialing I. Purpose The purpose of this Policy and Procedure is to establish the process including written guidelines and standards for the credentialing and re-credentialing of all clinicians defined in this policy.

More information

TRINITY HEALTH Minot, North Dakota MEDICAL STAFF PRE-APPLICATION FORM

TRINITY HEALTH Minot, North Dakota MEDICAL STAFF PRE-APPLICATION FORM TRINITY HEALTH Minot, North Dakota MEDICAL STAFF PRE-APPLICATION FORM Application Instructions: Complete the application in full. The application must be typed or neatly printed. Attach additional sheets

More information

Department: Legal Department. Approved by:

Department: Legal Department. Approved by: HAWAII HEALTH SYSTEMS C O R P O R A T I O N Touching Lives Everyday" Policies and Procedures Subject: Credentialing Requirements Department: Legal Department Issued by: Rene McWade, Esq. VP & General Counsel

More information

PROVIDER CREDENTIALING APPLICATION

PROVIDER CREDENTIALING APPLICATION PROVIDER CREDENTIALING APPLICATION We appreciate your interest in becoming a TRICARE network provider, offering medical services for Prime Beneficiaries. STEP 1. Contact your Provider Education and Relations

More information

Optima Health New Provider Application Packet

Optima Health New Provider Application Packet Optima Health New Provider Application Packet Thank you for your interest in becoming a participating provider in the Optima Health Network. Please review the following instructions to ensure acceptance

More information

Legal Last Name First Middle Professional Title/Degree

Legal Last Name First Middle Professional Title/Degree IOWA STATEWIDE UNIVERSAL PRACTITIONER RECREDENTIALING APPLICATION Type or print responses in ink. A CV or See CV may not be use in lieu of completing any answers on this application. Review or complete

More information

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip SCHNEIDER REGIONAL MEDICAL CENTER 9048 SUGAR ESTATE ST. THOMAS, U.S.V.I 00802 APPLICATION FOR TEMPORARY PRIVILEGES (USED FOR URGENT PATIENT NEED AND LOCUM TENENS) COMPLETE THE APPLICATION IN FULL. PRINT

More information

Molina Healthcare of Wisconsin, Inc. Practitioner Application

Molina Healthcare of Wisconsin, Inc. Practitioner Application Molina Healthcare of Wisconsin, Inc. Practitioner Application 1. INSTRUCTIONS This form should be: Typed or legibly printed in black or blue ink. Keep a copy of the application on file for future requests.

More information

Credentialing Application and Process

Credentialing Application and Process Credentialing Application and Process What is Credentialing? Credentialing is the process of obtaining, verifying and assessing the qualifications of a healthcare practitioner to provide patient care services

More information

Subject: Re-Credentialing Verification (Page 1 of 5)

Subject: Re-Credentialing Verification (Page 1 of 5) Subject: Re-Credentialing Verification (Page 1 of 5) Objective: I. To ensure that initial credentialed Health Share/Tuality Health Alliance (THA) providers have the continuing legal authority and relevant

More information

Values Accountability Integrity Service Excellence Innovation Collaboration

Values Accountability Integrity Service Excellence Innovation Collaboration n00256 Recredentialing Process Values Accountability Integrity Service Excellence Innovation Collaboration Abstract Purpose: The purpose of recredentialing is to assure that Network Health Plan/Network

More information

Network Participant Credentialing Application

Network Participant Credentialing Application Please: Type or print legibly Complete all items. If an item does not apply, enter NA. Do not leave any items blank. Include the following with your application, if applicable: Copy of professional license(s)

More information

Idaho Practitioner Application

Idaho Practitioner Application Idaho Practitioner Application To use the Idaho Practitioner Application (IPA), follow these instructions: Keep an unsigned and undated copy of the application on file for future requests. When a request

More information

An Orientation to Your Employee Assistance Program (EAP)

An Orientation to Your Employee Assistance Program (EAP) An Orientation to Your Employee Assistance Program (EAP) Presented by Linda Kushel-Hernandez Magellan Senior Account Executive 2015 Magellan Health, Inc Objectives Describe your EAP benefits. Identify

More information

Psychosocial Rehabilitation (PSR) H2017. Presented by the Clinical and Quality Teams September 2016

Psychosocial Rehabilitation (PSR) H2017. Presented by the Clinical and Quality Teams September 2016 Psychosocial Rehabilitation (PSR) H2017 Presented by the Clinical and Quality Teams After today s training you will be able to: Determine Department of Medical Assistance (DMAS) Medical Necessity Criteria

More information

Washington Practitioner Application

Washington Practitioner Application Washington Practitioner Application To use the Washington Practitioner Application (WPA), follow these instructions: Keep an unsigned and undated copy of the application on file for future requests. When

More information

Provider Rights and Responsibilities

Provider Rights and Responsibilities Provider Rights and Responsibilities This section describes Molina Healthcare s established standards on access to care, newborn notification process and Member marketing information for Participating

More information

The Plan will not credential trainees who do not maintain a separate and distinct practice from their training practice.

The Plan will not credential trainees who do not maintain a separate and distinct practice from their training practice. SUBJECT: PRIMARY CARE AND SPECIALTY PHYSICIAN INITIAL CREDENTIALING SECTION: CREDENTIALING POLICY NUMBER: CR-01 EFFECTIVE DATE: 1/01 Applies to all products administered by the Plan except when changed

More information

Idaho Practitioner Credentials Verification Checklist

Idaho Practitioner Credentials Verification Checklist Idaho Practitioner Credentials Verification Checklist The following documentation is required when submitting a practitioner credentialing application. Please complete the information below and return

More information

Aetna Better Health Hospital Credentialing Packet Table of Contents

Aetna Better Health Hospital Credentialing Packet Table of Contents Aetna Better Health Hospital Credentialing Packet 1. Cover Letter 2. Checklist 3. Medicaid Ownership Code Document 4. Credentialing Application 5. Behavioral Health Supplement 6. Medicaid Disclosure Form

More information

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE:

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE: *Required Fields LIBERTY DENTAL PLAN Dental Hygienist - Credentialing Application Please complete one application per Dental Hygienist Demographic Information: Male Female *HYGIENIST NAME: RDH Other *DATE

More information

Washington Practitioner Application

Washington Practitioner Application Washington Practitioner Application To use the Washington Practitioner Application (WPA), follow these instructions: Keep an unsigned and undated copy of the application on file for future requests. When

More information

ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Chiropractor

ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Chiropractor LOUISIANA Department of HEALTH and HOSPITALS ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Chiropractor (Enrollment packet is subject to change without notice)

More information

Independent Assessment, Certification and Coordination Team: Process Overview. Magellan of Virginia May 15, 2018

Independent Assessment, Certification and Coordination Team: Process Overview. Magellan of Virginia May 15, 2018 Independent Assessment, Certification and Coordination Team: Process Overview Magellan of Virginia May 15, 2018 Training Objectives Identify and describe important roles in the Independent Assessment,

More information

HONORHealth CREDENTIALING PROCEDURES MANUAL 2017

HONORHealth CREDENTIALING PROCEDURES MANUAL 2017 HONORHealth CREDENTIALING PROCEDURES MANUAL 2017 Table of Contents Part 1 APPOINTMENT PROCEDURES 1.1 Application 1 1.2 Application Content 1 1.3 References 2 1.4 Effect of Application 2 1.5 Application

More information

National Imaging Associates, Inc. (NIA) 1 Medical Specialty Solutions

National Imaging Associates, Inc. (NIA) 1 Medical Specialty Solutions National Imaging Associates, Inc. (NIA) 1 Medical Specialty Solutions Provider Training/Presented by: Name: Kevin Apgar 1 National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare,

More information

NIA Magellan 1 Medical Specialty Solutions

NIA Magellan 1 Medical Specialty Solutions NIA Magellan 1 Medical Specialty Solutions CeltiCare of Massachusetts Health Provider Training 1 - NIA Magellan refers to National Imaging Associates, Inc. NIA Magellan Training Program 2 NIA Magellan

More information

Medicare Manual Update Section 2 Credentialing (pg 15-23) SECTION 2: CREDENTIALING. 2.1 : Credentialing Policies & Procedures

Medicare Manual Update Section 2 Credentialing (pg 15-23) SECTION 2: CREDENTIALING. 2.1 : Credentialing Policies & Procedures SECTION 2: CREDENTIALING The credentialing program applies to all direct-contracted and those who are affiliated with Care1st through their relationship with a contracted PPG (delegated IPA/MG). Care1st

More information

Medi-cal Manual Update Section 9.14 Credentialing Program (pg )

Medi-cal Manual Update Section 9.14 Credentialing Program (pg ) 9.14: Credentialing Program Purpose To ensure that all network practitioners/providers meet the minimum credentials requirements set forth by Care1st and the regulatory agencies including, but not limited

More information

UPMC PINNACLE PROVIDER ENROLLMENT CREDENTIALING POLICIES AND PROCEDURES

UPMC PINNACLE PROVIDER ENROLLMENT CREDENTIALING POLICIES AND PROCEDURES SUBJECT: Provider Enrollment Delegated Credentialing & Recredentialing PURPOSE Credentialing/recredentialing is the process by which UPMC Pinnacle ensures the quality of all providers of health care services

More information

Subject: Initial Credentialing Verification (Page 1 of 5)

Subject: Initial Credentialing Verification (Page 1 of 5) Subject: Initial Credentialing Verification (Page 1 of 5) Objective: I. To ensure that Health Share/Tuality Health Alliance (THA) practitioners/providers have the legal authority and relevant training

More information

Provider Credentialing and Termination

Provider Credentialing and Termination PROVIDER CREDENTIALING AND TERMINATION PROVIDER CREDENTIALING Subject to limited exceptions, Fidelis Care is required to credential each health care professional, prior to the professional providing services

More information

SAMPLE - Verifying Credentialing Information Policy

SAMPLE - Verifying Credentialing Information Policy Subject: Number: Effective Date: Supersedes SPP# Approved by: (signature) Distribution: Verifying Credentialing Information Dated: Medical Staff, Credentialing Manual, Medical Staff Office I. STATEMENT

More information

ACCF Diabetes Collaborative Registry Program Requirements v1.2 Posted on 9/14/2015

ACCF Diabetes Collaborative Registry Program Requirements v1.2 Posted on 9/14/2015 Contents 1.0 Practice Responsibilities... 2 2.0 ACCF Responsibility... 3 3.0 Publication... 4 4.0 Sponsorship, Information to Sponsors, and No Obligation to Refer... 4 1 For existing PINNACLE Registry

More information

EPSDT Health Services

EPSDT Health Services LOUISIANA Department of HEALTH and HOSPITALS ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) EPSDT Health Services (Enrollment packet is subject to change without

More information

The Credentialing Process. Note! Contents are subject to change and are not a guarantee of payment.

The Credentialing Process. Note! Contents are subject to change and are not a guarantee of payment. The Credentialing Process Note! Contents are subject to change and are not a guarantee of payment. Introduction to Credentialing BlueCross BlueShield of South Carolina, BlueChoice HealthPlan of South Carolina

More information

Delegation Oversight 2016 Audit Tool Credentialing and Recredentialing

Delegation Oversight 2016 Audit Tool Credentialing and Recredentialing Att CRE - 216 Delegation Oversight 216 Audit Tool Review Date: A B C D E F 1 2 C3 R3 4 5 N/A N/A 6 7 8 9 N/A N/A AUDIT RESULTS CREDENTIALING ASSESSMENT ELEMENT COMPLIANCE SCORE CARD Medi-Cal Elements Medi-Cal

More information

Provider Handbook Supplement for Virginia Behavioral Health Service Administrator (BHSA)

Provider Handbook Supplement for Virginia Behavioral Health Service Administrator (BHSA) Magellan Healthcare of Virginia * Provider Handbook Supplement for Virginia Behavioral Health Service Administrator (BHSA) *In Virginia, Magellan contracts as Magellan Healthcare, Inc., f/k/a Magellan

More information

Ohio Department of Insurance

Ohio Department of Insurance Ohio Department of Insurance STANDARDIZED CREDENTIALING FORM Please complete each section thoroughly. Attach additional sheets where necessary. Type or print clearly in black ink. Sign and date the application.

More information

PILOT FUNDING FOR NEW RESEARCH (Pfund)

PILOT FUNDING FOR NEW RESEARCH (Pfund) PILOT FUNDING FOR NEW RESEARCH (Pfund) Request for Proposals DEADLINE DATE: Proposals Due: February 1, 2008 LOUISIANA EXPERIMENTAL PROGRAM TO STIMULATE COMPETITIVE RESEARCH (EPSCoR) Sponsored By: The National

More information

Credentialing Application

Credentialing Application Credentialing Application If you are active with CAQH it is not necessary for you to complete the application in this packet. In order for Meridian Health Plan to process your contract the following information

More information

ECD Global Alliance Erdheim-Chester Disease

ECD Global Alliance Erdheim-Chester Disease ECD Global Alliance Erdheim-Chester Disease Medical Research Grant Application Guidelines Thank you for your interest in medical research grants from the ECD Global Alliance (ECDGA). These guidelines provide

More information

KIDMED SCREENING CLINIC

KIDMED SCREENING CLINIC LOUISIANA Department of HEALTH and HOSPITALS ENROLLMENT PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) KIDMED SCREENING CLINIC (PT66) Revised 10/06 Louisiana Medicaid

More information

Credentialing and. Recredentialing. Plan

Credentialing and. Recredentialing. Plan Credentialing and Recredentialing Plan This Credentialing and Recredentialing Plan may be distributed to applying or participating Licensed Independent Practitioners, Hospitals and Ancillary Providers

More information

2014 Complete Overview of the URAC Standards

2014 Complete Overview of the URAC Standards 2014 Complete Overview of the URAC Standards Session Code: TU09 Time: 10:00 a.m. 11:30 a.m. Total CE Credits: 1.5 Presented by: Sandra Greenwalt, RN, BSN, MCHA, CCM, CCP, CPHQ URAC Provider Credentialing,

More information

Magellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program

Magellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program Magellan Healthcare 1 Magellan Complete Care of Virginia Musculoskeletal Care Management (MSK)Program 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. Magellan Healthcare

More information

NIA Magellan 1 Medical Specialty Solutions

NIA Magellan 1 Medical Specialty Solutions NIA Magellan 1 Medical Specialty Solutions Provider Training 1 NIA Magellan refers to National Imaging Associates, Inc. NIA Magellan Training Program 2 NIA Magellan Program Agenda Introduction to NIA Magellan

More information

Request for Proposal PROFESSIONAL AUDIT SERVICES

Request for Proposal PROFESSIONAL AUDIT SERVICES Request for Proposal PROFESSIONAL AUDIT SERVICES FORENSIC AUDIT OF CITY S FINANCE DEPARTMENT, URA ACCOUNTS AND DEVELOPMENT AUTHORITY ACCOUNTS PROCEDURES CITY OF FOREST PARK TABLE OF CONTENTS I. INTRODUCTION

More information

SAMPLE Credentialing, Privileging and Peer Review Self-Evaluation

SAMPLE Credentialing, Privileging and Peer Review Self-Evaluation 1. The following professionals are credentialed: Physicians Residents Advanced Practice Providers (e.g., CRNA, PA, CMW) Dentists Podiatrists Chiropractors Others 2. The credentialing process includes the

More information

Dean Health Plan Physical Medicine Overview

Dean Health Plan Physical Medicine Overview Dean Health Plan Physical Medicine Overview Provider Training / Presented by: Leta Genasci Above and throughout this document, NIA Magellan refers to National Imaging Associates, Inc. Dean Health Plan

More information

Medical Case Management

Medical Case Management Definition: services (including treatment adherence) is the provision of a range of consumer-centered consumer activities focused on improving health outcomes in support of the HIV Care Continuum. Consumer

More information

Why do we credential practitioners?

Why do we credential practitioners? CREDENTIALING 101 Why do we credential practitioners? Compliance with accreditation standards such as the American Accreditation Healthcare Commission (AAHC/URAC) and the National Committee for Quality

More information

Aetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers

Aetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers Aetna/Coventry Pennsylvania and West Virginia Physical Medicine Overview for Providers Aetna Physical Medicine Overview What: When: Who: Aetna will initiate a Utilization Management Prior Authorization

More information

Provider Selection Criteria for PreferredOne Participating Practitioners

Provider Selection Criteria for PreferredOne Participating Practitioners Provider Selection Criteria for PreferredOne Participating Practitioners General Criteria 1. Practitioner must serve a specialty and/or geographic need for the good of the PreferredOne product for which

More information

PILOT FUNDING FOR NEW RESEARCH (Pfund)

PILOT FUNDING FOR NEW RESEARCH (Pfund) PILOT FUNDING FOR NEW RESEARCH (Pfund) Request for Proposals number 2005-E DEADLINE DATE: Proposals Due: September 30, 2005 LOUISIANA EXPERIMENTAL PROGRAM TO STIMULATE COMPETITIVE RESEARCH (EPSCoR) Sponsored

More information

CLINICAL STAFF CREDENTIALING AND PRIVILEGING MANUAL

CLINICAL STAFF CREDENTIALING AND PRIVILEGING MANUAL CLINICAL STAFF CREDENTIALING AND PRIVILEGING MANUAL January 20, 2012 TABLE OF CONTENTS Introduction...1 I. Clinical Staff Membership...1 II. Clinical Staff Privileges...2 III. Procedures for Initial Appointment

More information

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED Dear Applicant: Enclosed in this reappointment application for membership to the Guadalupe Regional Medical Center (GRMC) Allied Health Professionals Staff, you will find the following. Allied Health Professional

More information

Therapeutic Day Treatment: Service Request Authorization Updates. Presented by Clinical November 1, 2016

Therapeutic Day Treatment: Service Request Authorization Updates. Presented by Clinical November 1, 2016 Therapeutic Day Treatment: Service Request Authorization Updates Presented by Clinical November 1, 2016 The Purpose of This Training To highlight the changes on the new Service Request Authorization (SRA)

More information

BCBS NC Blue Medicare Credentialing Instructions

BCBS NC Blue Medicare Credentialing Instructions BCBS C Blue Medicare Credentialing Instructions Licensed Certified Social Worker (LCSW) Certified Substance Abuse Counselor (CSAC) Licensed Clinical Addiction Specialist (LCAS) Licensed Marriage and Family

More information

CREDENTIALING Section 5

CREDENTIALING Section 5 Overview Credentialing is the process used by the Plan to evaluate the qualifications and credentials of providers, physicians, allied health professionals, hospitals and ancillary facilities/health care

More information

ALLIED HEALTH PROFESSIONAL CREDENTIALING APPLICATION FORM

ALLIED HEALTH PROFESSIONAL CREDENTIALING APPLICATION FORM ALLIED HEALTH PROFESSIONAL CREDENTIALING APPLICATION FORM Independent Practitioners: Acupuncturist, Audiologist, Dietitian, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed

More information

2015 Complete Overview of the NCQA Standards Session Code: TU13 Time: 2:30 p.m. 4:00 p.m. Total CE Credits: 1.5 Presenter: Frank Stelling, MEd, MPH

2015 Complete Overview of the NCQA Standards Session Code: TU13 Time: 2:30 p.m. 4:00 p.m. Total CE Credits: 1.5 Presenter: Frank Stelling, MEd, MPH 2015 Complete Overview of the NCQA Standards Session Code: TU13 Time: 2:30 p.m. 4:00 p.m. Total CE Credits: 1.5 Presenter: Frank Stelling, MEd, MPH Introduction to NCQA Credentialing Standards NAMSS Educational

More information

SAMPLE Medical Staff Self-Assessment Questionnaire

SAMPLE Medical Staff Self-Assessment Questionnaire Hospital Name: Person Completing the Assessment: Date: I. Executive Leadership Yes No 1. Is there a medical staff member or members on the governing board? 2. Does medical staff leadership meet routinely

More information

Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner

Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner Appendix B-1 Acceptance/continued participation criteria Primary care nurse practitioner Amendments to this Appendix B-1 shall be effective as of August 1, 2012 (the Amendment Date ). To be initially admitted

More information

CHAPTER 6: CREDENTIALING PROCEDURES

CHAPTER 6: CREDENTIALING PROCEDURES We want to help you become or continue as a participating in-network provider for our members. Please refer to this chapter for information about: Provider credentialing Provider recredentialing Provider

More information

CREDENTIALING PROCEDURES MANUAL MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA

CREDENTIALING PROCEDURES MANUAL MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA January 16, 1984 Revised: October 18, 1984 January 19, 1989 April 17, 1989 April 26, 1990 December 20, 1990 January 21, 1993 May 27, 1993 July

More information

MEDICAL STAFF CREDENTIALING APPLICATION FORM For MD; DO; DDS; DMD; DC; DPM; PharmD; PhD; PsyD; OD.

MEDICAL STAFF CREDENTIALING APPLICATION FORM For MD; DO; DDS; DMD; DC; DPM; PharmD; PhD; PsyD; OD. MEDICAL STAFF CREDENTIALING APPLICATION FORM For MD; DO; DDS; DMD; DC; DPM; PharmD; PhD; PsyD; OD. APPLICANT NAME: SPECIALTY: In order to expedite the credentialing process, please complete every item

More information

Magellan Healthcare 1 Medical Specialty Solutions

Magellan Healthcare 1 Medical Specialty Solutions Magellan Healthcare 1 Medical Specialty Solutions Horizon NJ Health 1 National Imaging Associates, Inc. is a subsidiary of Magellan Healthcare, Inc. Magellan Healthcare Training 2 Magellan Healthcare Agenda

More information

Page 1 of 6 ADMINISTRATIVE POLICY AND PROCEDURE

Page 1 of 6 ADMINISTRATIVE POLICY AND PROCEDURE Page 1 of 6 SECTION: Contracts SUBJECT: Credentialing DATE OF ORIGIN: 6/1/08 REVIEW DATES: 8/1/15, 2/8/17 EFFECTIVE DATE: 12/1/17 APPROVED BY: EXECUTIVE DIRECTOR I. PURPOSE: To have a written system in

More information

National Imaging Associates, Inc. (NIA) Medical Specialty Solutions

National Imaging Associates, Inc. (NIA) Medical Specialty Solutions National Imaging Associates, Inc. (NIA) Medical Specialty Solutions NIA Program Agenda Introduction Our Program 1. Expanded Program 2. Authorization Process 3. Clinical Validation of Records 4. Other Program

More information

UnitedHealthcare of Insurance Company of New York The Empire Plan. CREDENTIALING and RECREDENTIALING PLAN

UnitedHealthcare of Insurance Company of New York The Empire Plan. CREDENTIALING and RECREDENTIALING PLAN UnitedHealthcare of Insurance Company of New York The Empire Plan CREDENTIALING and RECREDENTIALING PLAN 2013-2014 2013 UnitedHealth Group The Empire Plan All Rights Reserved This Credentialing and Recredentialing

More information

Facility and Ancillary Credentialing Application INSTRUCTIONS

Facility and Ancillary Credentialing Application INSTRUCTIONS Facility and Ancillary Credentialing Application INSTRUCTIONS Please complete the application thoroughly in its entirety. The checklist below may not be exhaustive of all materials, but is provided as

More information

Credentialing and. Recredentialing. Plan

Credentialing and. Recredentialing. Plan Credentialing and Recredentialing Plan This Credentialing and Recredentialing Plan may be distributed to applying or participating Licensed Independent Practitioners, Hospitals and Ancillary Providers

More information

Managed Health Network

Managed Health Network Managed Health Network Practitioner Manual 2013 Practitioner Manual Table of Contents SECTION 1 OVERVIEW OF SERVICES... 5 1.1 EMPLOYEE ASSISTANCE PROGRAMS (EAP)... 5 1.2 MHN BEHAVIORAL HEALTH PLANS COMMERCIAL

More information

10111 Richmond Avenue, Suite 400, Houston, Texas (713) / (866) (Toll Free) / (713) (Fax)

10111 Richmond Avenue, Suite 400, Houston, Texas (713) / (866) (Toll Free) / (713) (Fax) Application Date: \ \ Date Available: \ \ Provider s Name: O MD O DO O PA O NP SS # : City: State: Zip: Home Phone ( ) Work Phone ( ) Pager ( ) Cell Phone ( ) E-Mail address: Driver s Lic. # Expires: \

More information