(form found on Mercy Maricopa website/for Providers/Forms/Section 3.20 Credentialing & Privileging)

Transcription

1 Network Credentialing Upon hire, at termination, and discipline change - Change/Add Form (form found on Mercy Maricopa website/for Providers/Forms/Section 3.20 Credentialing & Privileging) Individual Clinician Credentialing Application and supporting documentation Upon hire - (Change/Add form must be submitted & received before a credentialing application will be sent) Individual Clinician recredentialing application and supporting documentation 63 days prior to Credentialing Expiration Date - (Mercy Maricopa will send notification letters prior to Expiration Date) Every Three years - (Mercy Maricopa will notify provider prior to recredentialing due date to initiate the process) Privileging Application and supporting documentation Upon hire and prior to serving as a Clinical Liaison and/or conducting assessments Page 1 of 12 Last Updated 4/1/14

2 Organizational Credentialing Application and supporting documentation - (Existing providers will need to submit a request to add a service/program; New providers will need to request to join the network) 15 days after approval letter from Mercy Maricopa is received (Mercy Maricopa will send the credentialing application) Organizational recredentialing application and supporting documentation 63 days prior to Credentialing Expiration Date - (Mercy Maricopa will send notification letters prior to Expiration Date) DLS license & POC if applicable Proof of Insurance/Facility Individual Clinician license DEA (if applicable) Prior to Expiration Date Prior to Expiration Date Prior to Expiration Date Prior to Expiration Date Upon Expiration Page 2 of 12 Last Updated 4/1/14

3 Accreditation certificate Prior to Expiration Date Upon Expiration and survey report CSA Amendment CSA Initial Application CSA Renewal Provider Availability Database Ad Hoc - (Providers will need to request to join the network) 30 days prior to Amendment 15 days after approval letter from Mercy Maricopa is received 45 days prior to expiration Inpatient/Residential Bed Availability Database - (For residential and inpatient providers only) Mercy Maricopa of AZ website Minimum of 2x per Day Daily on Business Days - (see Process Flow posted in Section 10 of Mercy Maricopa Provider Manual) Outpatient Appointment Availability Database - (For Intake providers only) Mercy Maricopa of AZ website Provider Information Minimum of 2x per Day Daily on Business Days - (see Process Flow posted in Section 10 of Mercy Maricopa Provider Manual) Page 3 of 12 Last Updated 4/1/14

4 Comprehensive Staffing List Network Attention: \\PHXP-SFS- 001\ProvNet \CompProvRoster- Inbound Naming Convention: Network_CompProvRoster_##- #######_YYYYMMDD Notice that ##-####### is the Tax ID of the Provider Group. Update ly (if there are any changes) by the 5th day of every Key Workforce Reduction, with a plan to not fill, or delay filling the staff vacancies (no plan to fill within 60 days) Request (i.e. clinical director, BHTs, BHPs, peer/family support staff, etc.) Network Attention: Senior Contracts Manager Prior Approval Required Page 4 of 12 Last Updated 4/1/14

5 Service Capacity Addition/Reduction Requests (i.e. loss of a prescriber, specialty clinician or any staff or program that would cause disruption of services or availability of services, or would require a change to Scope of Work. Anything that is going to impact the ability to maintain DLS licensure.) Network Attention: Senior Contracts Manager Prior Approval Required Change in Provider Billing Type Requests (i.e. level of care conversion, etc.) Provider Relocation/Move Request Provider Notification of Failure to Meet Licensing Criteria Network Attention: Senior Contracts Manager Network Attention: Senior Contracts Manager Network Attention: Senior Contracts Manager Prior Approval Required Prior Approval Required for Moves Greater than 5 miles, 45 day Notification for all Moves Immediate Notification Required Page 5 of 12 Last Updated 4/1/14

6 Provider Requests to Network Immediate Notification Stop Accepting Attention: Senior Required once New TXIX or Priority When decision has been Contracts Manager Recipients made Provider Termination, Suspension, Limitation or Material Change of Network RBHA Contract 45 day Notification prior to Attention: Senior Contracts Notification (i.e. site any change Manager closure, facility fire, foreclosure, staff strike, etc.) SAPT SAPT Wait List Attention: GMH/SA Administrator 60 days after the Quarter ends HIV Report Attention: Medical Management 30 days after the ends Deaf and Hard of Hearing Services Survey Cultural Competence Organizational Self- Assessment Cultural Competency Provider Survey Cultural Competency - Attention: Cultural Competency Administrator Cultural Competency - Attention: Cultural Competency Administrator To be implemented at request of RBHA. To be implemented at request of RBHA. Page 6 of 12 Last Updated 4/1/14

7 Prevention QTR 1 (July-Sep): October 31st; QTR 2 (Oct- Dec): Prevention Quarterly Prevention Administrator January 31st; QTR 3 (Jan- Report Mar): April 30th; QTR 4 (Apr- Quarterly Jun): July 31st Annual Report Prevention Administrator July 31st Strategic Plans Prevention Administrator April 15th Program Descriptions APREDS April 15th Quality Improvement Provide QM with all data required to achieve the goals in the RBHA QM plan and work plan and as required for special projects or reporting requirements Varies based upon request. When Requested Provide QM with corrective actions/pips as requested TXIX/XXI Eligibility Screening Report As requested The 5th calendar day each Page 7 of 12 Last Updated 4/1/14

8 Part D Enrollment and The 5th calendar day each Limited Income Subsidy Report For all Direct Service Sites Staff to Consumer Ratio The 5th calendar day each Report The 5th calendar day each Current ISP Production Clinic Scorecard Site The 5th calendar day each Contribution Tool For all Intake Providers Access to Care 7 Day The 5th calendar day each Routine Referral Log For all Child Providers and Provider Network Organizations Adult PNO Report NXIX HEA Tracking Children's System of Care - Quality Management Data Structural Elements Reports Child Crisis Network Children structural report Attention: Adult System of Care Administrator Attention: Adult System of Care Administrator For UPC and PRC-W The 5th calendar day each Fridays The 5th calendar day each The 5th calendar day each The 5th calendar day each Weekly Page 8 of 12 Last Updated 4/1/14

9 UPC and PRC-W Data Submission Template and Data Collection Tool The 10th calendar day each Corrective Action Requested documentation regarding a grievance Attendance at an informal conference Incident, Accident, Death Reports Seclusion and Restraint Reports Seclusion and Restraint Report Attention: Grievance Investigator Attention: Grievance Investigator Grievance and Appeals Usually 30 days from request Within 48 hours of request When requested As needed May attend by phone Within 7 days of appeal When requested Risk Management Within 24 hours of Attention: Risk Management occurrence When occurs Attention: Risk Management Within 5 days of occurrence When occurs Attention: Risk Management By the 5th of each Performance Improvement: for all Inpatient Providers Medical Care Evaluation Studies (MCE) Request for Registration April 15th Annual Page 9 of 12 Last Updated 4/1/14

10 QTR 1 (July-Sep): October MCE Quarterly Reports 10; QTR 2 (Oct-Dec): January 10; QTR 3 (Jan- Mar): April 10; QTR 4 (Apr- Jun): July 10 Quarterly Summary of Methodology May 31st Annual Abstract of Final Study Results July 31st Annual Provider Monitoring Provide data and assistance with clinical record review and other types of Provider monitoring. Prepare for on-site availability to provider monitoring auditors Standard Clinical Record Review: 2 weeks from request / Ad Hoc Review: As soon as possible When Requested Data Analysis and Reporting State Consumer Attention: Data Analysis and Satisfaction Survey Reporting TBD Annual Quality Improvement Initiatives Treatment Record Reviews TBD TBD As necessary Practice Guidelines TBD TBD As necessary Outcomes Initiatives TBD TBD As necessary Provider Profiling TBD TBD As necessary Other QI Initiatives TBD TBD As necessary FINANCE For contract revenues less than $250,000 Page 10 of 12 Last Updated 4/1/14

11 Un-audited Financial Statements Attention: Finance 120 days after year-end For contract revenues between $250,000 and $499,999 Un-audited Financial Statements Attention: Finance 30 days after quarter-end Quarterly For contract revenues of $500,000 or more Un-audited Financial Statements Attention: Finance 30 days after quarter-end Quarterly Two (2) copies of annual certified financial report along with any management letters Attention: Finance 120 days after year-end Sub recipient of Federal Funds and required to obtain an OMB Circular A-133 audit 30 days after receipt and no Two (2) copies of the A- Attention: Finance later than 120 days after 133 Audit Report year-end Quarterly Financial Statement Certification Statement Attention: Finance 30 days after quarter-end Quarterly Statement of Financial Position Attention: Finance 30 days after quarter-end Quarterly Statement of Financial Position Disclosures (if Attention: Finance 30 days after quarter-end Quarterly applicable) Statement of Activities Attention: Finance 30 days after quarter-end Quarterly Statement of Changes in Net Assets Attention: Finance 30 days after quarter-end Quarterly Page 11 of 12 Last Updated 4/1/14

12 Annual Financial statement Statement of Financial Position Attention: Finance 120 days after year-end Statement of Financial Position Disclosures (if Attention: Finance 120 days after year-end applicable) Statement of Activities Attention: Finance 120 days after year-end Statement of Changes in Net Assets Attention: Finance 120 days after year-end Where audited statements are required, all opinion Attention: Finance 120 days after year-end letters must be included. OMB Circular A-133 audit program specific schedules Attention: Finance 30 days after receipt and no later than 120 days after year-end Page 12 of 12 Last Updated 4/1/14