Lakeshore RE AFP POLICY # 4.4. APPROVED BY: Board of Directors
|
|
- Simon Curtis
- 4 years ago
- Views:
Transcription
1 Lakeshore PIHP POLICY TITLE: CREDENTIALING, RECREDENTIALING, STAFF QUALIFICATIONS, AND BACKGROUND CHECKS Topic Area: Provider Network Management POLICY # 4.4 Page: 1 of ISSUED BY: Chief Executive Officer REVIEW DATES Adapted from Lakeshore Behavioral Health Alliance Applies to: Lakeshore Regional Entity (LRE) staff and all member CMHSPs APPROVED BY: Board of Directors Developed and Maintained by: PIHP Provider Network Management Workgroup Effective Date: Revised Date: Supersedes: N/A I. Policy: The LRE provider network management functions will assure that all affiliate members meet all requirements for credentialing, privileging, and primary source verification of professional staff. In addition, the LRE shall require all provider organizations to adopt, maintain and follow a policy for the completion of background checks. The LRE CEO or other designated LRE staff person will provide oversight of these functions to assure that each CMSHP is adhering to LRE policy and procedure. CMHSPs will credential, privilege, and verify providers as appropriate and when possible allow reciprocity with common providers. II. Purpose: To ensure that the LRE has an established policy for its provider network to assure that all consumers receive quality services in accordance with the mission and values of the affiliation, and are safe from predictable harm or risk. The LRE intends to provide qualified staff and organizations that meet or surpass all standards, and to assure that consumers are served by individuals who have been screened for good moral character and other regulatory standards. III. Applicability and Responsibility: This policy applies to LRE and its member CMHSPs. IV. Monitoring and Review: CMHSPs will assure that organizational and practitioner credentialing and monitoring occurs for all providers directly operated by or under sub-contract to the CMHSP. LRE shall annually conduct a compliance review of each CMHSP, and shall assure that all aspects of this policy are consistently implemented. Based on this compliance review, LRE may request corrective action from CMHSP. LRE
2 may request information regarding compliance with this policy at any time. LRE will provide rationale for the request, and will provide a reasonable timeline for provision of the information. CMHSPs shall minimally assure the following: A. CMHSPs shall assure that all individuals, whether employed or contracted by the CMHSP to provide clinical or medical services, will be credentialed consistent with their position. B. Credentials shall be verified, by primary source, prior to employment. C. Verification shall occur at the time of license renewal and renewal of provider agreement. D. Copies of all licenses, registrations, and/or certifications shall be kept in the employees or contractors files. E. Prior to employment, the CMHSP shall verify that the individual is not included in any excluded or sanctioned provider lists. This includes Medicaid/Medicare Exclusion lists and National Practitioner Data Bank lists. This verification process shall also occur at the time of recredentialing or contract renewal. F. Background checks shall include criminal, recipient rights, corporate compliance, driving record, Sex Offenders Registry, reference checks. G. The CMHSP incorporates its findings on credentialing, background checks, and exclusionary data into the LRE Quality Assessment Performance Improvement Program. Such findings will also be incorporated into the re-credentialing process. H. When applicable, all clinicians and physicians, whether employed or contracted by the CMHSP, will be privileged for each specific function to be performed. Privileging shall be age and disability specific according to the populations served. Clinical privileging shall occur at the time of employment and at least bi-annually thereafter. I. Monitor sub-contractors, at least annually, with adherence to above. V. Related Policies and Procedures: A. Network Development and Procurement B. Provider Contract Management and Oversight C. Network Policy Development D. MDCH Credentialing and Re-Credentialing Process, September 2006 E. CFR (b) (2) F. MDCH G. CFR H. CFR (c) VI. Definitions: Credentialing process by which the PIHP and its Affiliates ensure providers meet certain criteria and remain in compliance with the criteria in order to be accepted as a network provider. Re-credentialing process by which the PIHP and its Affiliates ensure that providers meet certain criteria and remain in compliance with the criteria in order to continue as a network provider. VII. Procedures
3 A. The members will have a written system in place for credentialing and re-credentialing individual practitioners included in their provider network that are not operating as part of an organizational provider. 1. Credentialing and re-credentialing will be conducted and documented for at least the following health care professionals: Physicians (M.D.s or D.O.s), Physician s Assistants, Psychologists (Licensed, Limited License or Temporary License), Licensed Master s Social Workers, Licensed Bachelor s Social Workers, Limited License Social Workers, or Registered Social Service Technicians Licensed Professional Counselors, Nurse Practitioners, Registered Nurses, or Licensed Practical Nurses, Occupational Therapists, or Occupational Therapist Assistants, Physical Therapists, or Physical Therapist Assistants, and Speech Pathologists. 2. LRE or its members will ensure that the credentialing and re-credentialing processes does not discriminate against: a. A health care professional, solely on the basis of license, registration, or certification. b. A health care professional who serves high-risk populations or who specializes in the treatment of conditions that require costly treatments. 3. LRE retains the right to approve, suspend, or terminate a provider selected by the members. 4. CMHSPs shall have a written credentialing policy and procedure that will reflect the scope, criteria, timeliness and process for the credentialing and re-credentialing of all of its providers, licensed and non-licensed. Policy will specify the administrative staff person and entity (e.g., credentialing committee) responsible for oversight and implementation of the credentialing/re-credentialing processes and delineate their roles. 5. CMHSPs shall ensure that an individual credentialing/ re-credentialing file is maintained for each credentialed provider. Each file must include: a. The initial credentialing and all subsequent re-credentialing applications; b. Information gained through primary source verification; and c. Any other pertinent information used in determining whether or not the provider met the Member s credentialing and re-credentialing standards. 6. CMHSPs credentialing/re-credentialing policy shall describe the methodology used to document and ensure that each credentialing/re-credentialing file was reviewed for completeness prior to presentation to their respective credentialing/re-credentialing authority, (e.g. credentialing committee). 7. The LRE Medical Director provides consultation to the LRE Executive Director regarding credentialing/re-credentialing of medical staff. Each Member s policy shall specify the role of providers in the credentialing/re-credentialing process.
4 B. Initial Credentialing 1. CMHSP policies and procedures for the initial credentialing of the individual practitioners must require: a. A written application that is completed, signed and dated by the provider and attests to the following elements: i. Lack of present illegal drug use. ii. Any history of loss of license and/or felony convictions. iii. Any history of loss or limitation of privileges or disciplinary action iv. Attestation by the applicant of the correctness and completeness of the application. b. An evaluation of the provider s work history for the prior five (5) years. c. Verification from primary sources of: i. Licensure or certification. ii. Board Certification, or highest level of credentials attained if applicable, or completion of any required internships/residency programs, or other postgraduate training. iii. Documentation of graduation from an accredited school. iv. National Practitioner Databank (NPDB), Healthcare Integrity and Protection Databank (HIPDB) query or, in lieu of the NPDB/HIPDB query, all of the following must be verified: v. Minimum five year history of professional liability claims resulting in judgment or settlement; vi. Disciplinary status with regulatory board or agency; and vii. Medicare/Medicaid sanctions. 2. If the individual practitioner undergoing credentialing is a physician, the physician profile information obtained from the American Medical Association may be used to satisfy the primary source requirements of (a), (b), and (c) above. C. Temporary/Provisional Credentialing of Individual Practitioners 1. Temporary or provisional credentialing of individual practitioners is intended to increase the available network of providers in underserved areas, whether rural or urban. Affiliates must have policies and procedures to address granting of temporary or provisional credentials when it is in the interest of Medicaid beneficiaries that providers be available to provide care prior to formal completion of the entire credentialing process. Temporary or provisional credentialing shall not exceed 150 days. CMHSPs shall have up to 31 days from receipt of a complete application, accompanied by the minimum documents identified below, within which to render a decision regarding temporary or provisional credentialing. 2. For consideration of temporary or provisional credentialing, at a minimum, a provider must complete a signed application consistent with requirements from the initial
5 credentialing process (VI.B.1.a, VI.B.1.b). 3. CMHSPs must conduct primary source verification of the following: a. Licensure or certification; b. Board certification, if applicable, or the highest level of credential attained; and c. Medicare/Medicaid sanctions. 4. CMHSPs must review the information obtained and determine whether to grant provisional credentials. Following approval of provisional credentials, the process of verification as outlined in this Section, should be completed. D. Re-credentialing Individual Practitioners 1. CMHSPs must identify policies and procedures that address the re-credentialing process for physicians and other licensed, registered or certified health care providers and include requirements for each of the following: a. Re-credentialing at least every two years. b. An update of information obtained during the initial credentialing; c. A process for on-going monitoring, and intervention if appropriate, of provider, which must include, at a minimum, review of: i. Medicare/Medicaid sanctions. ii. State sanctions or limitations on licensure, registration or certification. iii. Member concerns which include grievances (complaints) and appeals. iv. Any quality issues identified by affiliates or LRE. E. LRE Credentialing of Organizational Providers and Delegation of Credentialing to the Members of its Provider Network 1. LRE will validate and re-validate at least every two years that the organizational provider (community mental health agency or coordinating agency for substance abuse services) is licensed as necessary to operate in the State of Michigan and has not been excluded from Medicare or Medicaid participation. 2. LRE will delegate to the Members the function of credentialing and re-credentialing. The Affiliate s policy will specify the role of providers in the credentialing and recredentialing process. 3. LRE retains the right to approve, suspend, or terminate a provider selected by the Member. 4. The LRE Executive Director or designate is responsible for oversight of the delegated credentialing or re-credentialing decisions. F. Deemed Status 1. LRE will accept the credentialing decisions of other Prepaid Inpatient Health Plans (PIHPs) for individual practitioners and organizational providers, and will maintain
6 copies of the credentialing PIHP s decisions. G. Notification of Adverse Credentialing Decision 1. An individual practitioner or organizational provider that is denied credentialing or recredentialing shall be informed of the reasons for the adverse credentialing decision in writing by LRE or the Member and the appeals process within ten (10) business days of rendering the decision. H. Appeal of Adverse Credentialing Decision 1. LRE, and each CMHSP, shall develop a written process for responding to appeals of credentialing decision. Providers will submit a written request for reconsideration of the decision. LRE or CMHSPs will review the written request and inform the provider of their decision in writing within thirty (30) days. The LRE Executive Director will provide additional steps with timelines for appeal up to the LRE Board of Directors, whose decision will be considered final. 2. If the provider fails to submit a complete and timely request for a reconsideration or a request for a hearing with the Credentialing Appeals Board or the PIHP Board of Directors, the provider will be deemed to have accepted the PIHP s determination of the issues raised by the provider and to have waived all further internal or external processes regarding the issues. I. Reporting Requirements 1. The LRE and all affiliates shall report improper organizational provider or individual practitioner conduct that results in suspension or termination from the Member s provider network to the appropriate authorities such as; MDCH Bureau of Health Professions, Health Investigative Division; MDCH Office of Attorney General, Health Care Fraud Division/Program Investigations Section; and the individual or organization s Regulatory/Licensing Board. Criminal offenses should be reported to law enforcement. Such procedures shall be consistent with current Federal and State requirements, including those specified in the MDCH Medicaid Specialty Supports and Services Contract and the Balanced Budget Act of 1996.
POLICY No. 20-049. Prepared by: Judith Kell Effective: December 20, 2002 Compliance Review Supervisor Revised: January 23, 2009
LAKESHORE BEHAVIORAL HEALTH ALLIANCE Community Mental Health Services of Muskegon County Community Mental Health of Ottawa County Lakeshore Coordinating Council for Substance Abuse Services POLICY Prepared
PATHWAYS CMH. CATEGORY: Personnel Employee Guidelines BOARD APPROVAL DATE: June 4, 2014 REVISION(S) TO POLICY OTHER REVISION(S):
PATHWAYS CMH POLICY TITLE: Credentialing Credentialing & Oversight EFFECTIVE DATE: June 4, 2014 REVIEWED DATE: June 30, 2015 RESPONSIBLE PARTY: COO/Human Resources Director CATEGORY: Personnel Employee
GENESEE COUNTY Date Issued: 01-1999 COMMUNITY MENTAL HEALTH Date Revised: 08-2011 PIHP POLICY MANUAL SUBJECT:
GENESEE COUNTY Date Issued: 01-1999 COMMUNITY MENTAL HEALTH Date Revised: 08-2011 PIHP POLICY MANUAL SUBJECT: Page 1 of 7 WRITTEN BY: T. Deeghan, COO TECHNICAL REVIEW BY: T. Deeghan, S. Mason AUTHORIZED
Arizona Department of Health Services Division of Behavioral Health Services PROVIDER MANUAL
Section 3.20 Credentialing and Recredentialing 3.20.1 Introduction 3.20.2 References 3.20.3 Scope 3.20.4 Did you know? 3.20.5 Definitions 3.20.6 Objectives 3.20.7 Procedures 3.20.7-A. General process for
Lakeshore Regional Entity
Policy 4.2 POLICY TITLE: Contract Management POLICY #: 4.2 Adapted from SMA Topic Area: Applies to: Provider Network Management LRE and all member CMHSPs Page 1 of 5 ISSUED BY: Chief Executive Officer
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:
Policies of the University of North Texas Health Science Center. Chapter 14 UNT Health. 14.340 Credentialing and Privileging Licensed Practitioners
Policies of the University of North Texas Health Science Center 14.340 Credentialing and Privileging Licensed Practitioners Chapter 14 UNT Health Policy Statement. UNT Health shall credential and grant
CREDENTIALING OF PROVIDERS
Page Number 1 of 8 TITLE: CREDENTIALING OF PROVIDERS PURPOSE: The Center for Health Care Services (CHCS) will ensure each provider possesses the required education, certification or license, training,
PATHWAYS CMH. POLICY TITLE: Credentialing - Continuous Monitoring of Provider Network EFFECTIVE DATE: June 4, 2014 REVIEWED DATE: June 30, 2015
PATHWAYS CMH POLICY TITLE: Credentialing - Continuous Monitoring of Provider Network EFFECTIVE DATE: June 4, 2014 REVIEWED DATE: June 30, 2015 RESPONSIBLE PARTY: COO/Human Resources Director CATEGORY:
Policy No.: CR001_011. Title: Credentialing and Recredentialing Policy. applicable): QM CR 04 01, CR 07 01 Policy Review Frequency: Annual
Title: Credentialing and Recredentialing Policy Previous Title (if applicable): Department Applicability: Credentialing and, Contracting Lines of Business: Medi Cal, Healthy Families, Healthy Kids, Agnews
Southwest Michigan Behavioral Health
Southwest Michigan Behavioral Health Southwest Michigan Behavioral Health is an affiliation of Barry County Community Mental Health Authority, Kalamazoo Community Mental Health & Substance Abuse Services,
WRAPAROUND MILWAUKEE Policy & Procedure
WRAPAROUND MILWAUKEE Policy & Procedure Wraparound Wraparound-REACH FISS Project O-Yeah I. POLICY Date Issued: 11/15/07 Effective Date: 1/1/15 Reviewed: 10/20/14 By: WA Last Revision: 10/20/14 Subject:
Policy No.: CR006_07. Title: Delegated Credentialing and Recredentialing Policy QM CR 04 02, CR 07 08
Title: Delegated Credentialing and Recredentialing Policy Previous Title (if applicable): Department Applicability: Credentialing Lines of Business: Medi Cal, Healthy Families, Healthy Kids, Agnews Originating
REHAB PROVIDER NETWORK Professional Staff Credentialing Form
REHAB PROVIDER NETWORK Professional Staff Credentialing Form ***** THERAPIST LICENSE MUST BE ATTACHED TO THIS FORM ***** The information requested on this form is required to certify your status as a licensed
Subject: Overview of Credentialing of Practitioners Pg 1 of 11
Subject: Overview of Credentialing of Practitioners Pg 1 of 11 Objective: I. To ensure that Tuality Health Alliance (THA) uses a well defined credentialing and recredentialing process for evaluating and
Subject: Overview of Credentialing (Page 1 of 8)
Subject: Overview of Credentialing (Page 1 of 8) Objective: I. To ensure that Health Share/Tuality Health Alliance (THA) uses a well-defined credentialing and re-credentialing process for evaluating and
CREDENTIALING PLAN SECTION ONE INDIVIDUAL PROVIDERS
CREDENTIALING PLAN SECTION ONE INDIVIDUAL PROVIDERS I. STATEMENT OF POLICY A. The purpose of Avera Credentialing Verification Service (CVS) is to provide credentialing and recredentialing primary source
Pages: 9 Date: 03/13/2012 Subject: Credentialing and Recredentialing. Prepared By: MVBCN Clinical Director
Governing Body: Mid-Valley Behavioral Care Network (MVBCN) Pages: 9 Date: 03/13/2012 Subject: Credentialing and Recredentialing Prepared By: MVBCN Clinical Director Approved By: Oregon Health Authority
ATTACHMENT I. CAMHD Credentialing and Recredentialing
RFP No. HTH 460-08-03 ATTACHMENT I CAMHD Credentialing and Recredentialing A8541 SUBJECT: Initial Credentialing of Licensed Health Care Number: 80.308 Professionals Page: 1 of 29 REFERENCE: HRS; HI QUEST;
NATIONAL PRACTITIONER DATA BANK CHANGES AFFECT PODIATRISTS. Kern Augustine Conroy & Schoppmann, P.C.
NATIONAL PRACTITIONER DATA BANK CHANGES AFFECT PODIATRISTS Kern Augustine Conroy & Schoppmann, P.C. Effective March 1, 2010, new regulations governing the National Practitioner Data Bank (NPDB) became
Credentialing/Recredentialing
Credentialing/Recredentialing Section F-1 Credentialing Practitioner Credentialing Molina Healthcare of New Mexico, Inc. (Molina Healthcare) credentials practitioners/providers in accordance with internal
Licensed Counselors (LPCC)
CREDENTIALING Molina Healthcare of Ohio s credentialing process is designed to meet the standards of the National Committee for Quality Assurance (NCQA). In accordance with those standards, Molina Healthcare
CREDENTIALING PROCEDURES MANUAL
CREDENTIALING PROCEDURES MANUAL Page PART I Appointment Procedures 1 PART II Reappointment Procedures 5 PART III Delineation of Clinical Privileges Procedures 7 PART IV Leave of Absence, Reinstatement,
1) ELIGIBLE DISCIPLINES
PRACTITIONER S APPLICABLE TO ALL INDIVIDUAL NETWORK PARTICIPANTS AND APPLICANTS FOR THE PREFERRED PAYMENT PLAN NETWORK, MEDI-PAK ADVANTAGE PFFS NETWORK AND MEDI-PAK ADVANTAGE LPPO NETWORK. 1) ELIGIBLE
MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY, INC. POLICY & PROCEDURES
NUMBER: PAGE: 1 OF: 12 ADOPTED FROM: NACHC REVIEWED BY: Executive Team, Board of Directors DATES OF REVISION: APPROVED: July 21, 2011 DATES OF REVIEW: July 21, 2011 1. POLICY: This policy applies to all
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
DEPARTMENT OF MENTAL HEALTH POLICY/PROCEDURE
1 of 7 APPROVED BY: Director SUPERSEDES 07/01/2010 ORIGINAL ISSUE 07/01/2010 DISTRIBUTION LEVEL(S) 1 PURPOSE 1.1 To outline the structure, composition and functions of the Credentialing Review Committee
UnitedHealthcare. Credentialing Plan 2013-2014
UnitedHealthcare Credentialing Plan 2013-2014 Table of contents Section 1.0 Introduction... 1 Section 1.1 Purpose...1 Section 1.2 Credentialing Policy...1 Section 1.3 Authority of Credentialing Entity
Behavioral Healthcare, Inc. 155 Inverness Drive West Suite 201 Englewood, CO 80112
1 of 21 I. Policy: To maintain a quality provider network, Behavioral Healthcare Inc. (BHI) will establish credentialing and recredentialing criteria and processes to evaluate and determine participation
MAGELLAN HEALTH SERVICES ORGANIZATION SITE - SITE REVIEW PACKET 2011. Behavioral Health Intervention Services (BHIS) ONLY
MAGELLAN HEALTH SERVICES ORGANIZATION SITE - SITE REVIEW PACKET 2011 Behavioral Health Intervention Services (BHIS) ONLY Proprietary: Magellan Health Services policies apply to all subsidiaries,including
HOSPITAL SERVICES CORPORATION CREDENTIALS VERIFICATION SERVICES POLICIES AND PROCEDURES TABLE OF CONTENTS
HOSPITAL SERVICES CORPORATION CREDENTIALS VERIFICATION SERVICES POLICIES AND PROCEDURES TABLE OF CONTENTS I. Application Process and Policy A. The Joint Commission Introduction... 1 B. NCQA Introduction...
Los Angeles County Department of Mental Health Credentialing Application for Prescribing Practitioners Delivering Services to DCFS Children
Los Angeles County Department of Mental Health Credentialing Application for Prescribing Practitioners Delivering Services to DCFS Children This application is exclusively for prescribing practitioners
Credentialing CREDENTIALING
CREDENTIALING Based on standards set forth by the National Committee for Quality Assurance (NCQA) all Providers listed in literature for Molina Healthcare will be credentialed. All designated practitioners,
PROVIDER APPLICATION
COMMUNITY MENTAL HEALTH AFFILIATION OF MID-MICHIGAN PROVIDER APPLICATION Thank you for your interest in becoming a provider of the Community Mental Health Affiliation of Mid-Michigan (CMHAMM) provider
VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION
VANTAGE HEALTH PLAN FACILITY CREDENTIALING APPLICATION GENERAL INFORMATION Primary Practice Facility Location The type of application being submitted: Initial Credentialing Re-Credentialing Hospital (Acute,
PRACTITIONER CREDENTIALING APPLICATION Advanced Practice Nurse Prescriber, Certified Nurse Midwife, Physician Assistant
PRACTITIONER CREDENTIALING APPLICATION Advanced Practice Nurse Prescriber, Certified Nurse Midwife, Physician Assistant Prior to submitting this application it is required that you contact the Provider
POLICY REGARDING ADVANCED PRACTICE NURSES, PHYSICIAN ASSISTANTS AND OTHER CREDENTIALED HEALTH CARE PROVIDERS
MEDICAL-DENTAL STAFF BYLAWS, POLICIES, AND RULES AND REGULATIONS OF CHRISTIANA CARE HEALTH SERVICES, INC POLICY REGARDING ADVANCED PRACTICE NURSES, PHYSICIAN ASSISTANTS AND OTHER CREDENTIALED HEALTH CARE
Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (Adopted 2012)
Guidelines for Updating Medical Staff Bylaws: Credentialing and Privileging Physician Assistants (Adopted 2012) Executive Summary of Policy Contained in this Paper Summaries will lack rationale and background
CREDENTIALING POLICY OF UNIVERSITY OF UTAH HOSPITAL AND CLINICS
CREDENTIALING POLICY OF UNIVERSITY OF UTAH HOSPITAL AND CLINICS Revised November, 2004 TABLE OF CONTENTS PAGE 1. DEFINITIONS...1 1.A DEFINITIONS...1 1.B TIME LIMITS...2 1.C DELEGATION OF FUNCTIONS...2
PROVIDER CREDENTIALING & RE-CREDENTIALING CRITERIA MEDICAID. Credentialing & Re-Credentialing Criteria Medicaid qmc092314 Page 1 of 15
PROVIDER CREDENTIALING & RE-CREDENTIALING CRITERIA MEDICAID Credentialing & Re-Credentialing Criteria Medicaid qmc092314 Page 1 of 15 Sandhills Center Credentialing Criteria Agency/Facility: The agency/facility
New Jersey Physician Recredentialing Application (Please type or print)
New Jersey Physician Recredentialing Application (Please type or print) All sections must be completed fully or clearly marked as not applicable. No area should be left blank. SECTION 1 Personal Information
COMMUNITY MENTAL HEALTH PARTNERSHIP OF SOUTHEASTERN MICHIGAN/PIHP Department: Author: Approval Date 3/17/14
COMMUNITY MENTAL HEALTH PARTNERSHIP OF SOUTHEASTERN MICHIGAN/PIHP Department: Author: Approval Date 3/17/14 Policy and Procedure Employee Competency & Credentialing Policy Local Policy Number (if used)
Nonphysician Practitioner Policy a.k.a. Specified Professional Personnel Policy
RENOWN REGIONAL MEDICAL CENTER Nonphysician Practitioner Policy a.k.a. Specified Professional Personnel Policy (The Term Allied Health Professional will not be used in this policy since in the Renown Regional
STONY BROOK UNIVERSITY HOSPITAL CREDENTIALING POLICY
STONY BROOK UNIVERSITY HOSPITAL CREDENTIALING POLICY Stony Brook University Hospital (SBUH) has established policy guidelines for credentialing and recredentialing providers of patient care services at
IX. Network Management
A. ValueOptions' Network Department As part of the efforts to develop a state-of-the-art behavioral health system in Texas, ValueOptions recognizes and acknowledges the provider network is not only crucial
Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals
IOWA PLAN F BEHAVIAL HEALTH RE: Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services
This policy applies to: Stanford Hospital and Clinics Lucile Packard Children s Hospital. Date Written or Last Revision: Oct 2012
Providers Page 1 of 13 I. PURPOSE To establish mechanisms for gathering relevant data that will serve as the basis for decisions regarding credentialing and privileging of licensed independent practitioners
PHARMACY TECHNICIAN LICENSING IN MICHIGAN
PHARMACY TECHNICIAN LICENSING IN MICHIGAN February 27, 2015 LICENSE TYPES and Active Licensees Full License Examination Limited Employer Verification Temporary Preparing to take the examination As of February
MEDICAL STAFF POLICY & PROCEDURE
240 Maple Street PO Box 470 Woodruff, WI 54568 (715) 356-8000 MEDICAL STAFF POLICY & PROCEDURE NUMBER: MS.4 EFFECTIVE/APPROVAL DATE: TITLE: CREDENTIALING POLICY REVISION DATE: 4/97; 1/98; 7/98; 2/99; 12/00;
HOUSE BILL No. 2577 page 2
HOUSE BILL No. 2577 AN ACT enacting the addictions counselor licensure act; amending K.S.A. 74-7501 and K.S.A. 2009 Supp. 74-7507 and repealing the existing section; also repealing K.S.A. 65-6601, 65-6602,
NORTHCARE NETWORK. POLICY TITLE: Event/Death Reporting, Notification & Monitoring EFFECTIVE DATE: 10/1/10 (Retro.) REVIEW DATE: 12/18/13
NORTHCARE NETWORK POLICY TITLE: Event/Death Reporting, Notification & Monitoring EFFECTIVE DATE: 10/1/10 (Retro.) REVIEW DATE: 12/18/13 RESPONSIBLE PARTY: Quality Improvement Coordinator CATEGORY: Quality
Allied Health Care Provider: Appointment and Re-appointment
Allied Health Care Provider: Appointment and Re-appointment Document Owner: Lawson, Louise Version: 8 Effective Date: 10/23/2013 Revision Date: 4/26/2015 Approvers: Calkins, Paul; Del Boccio, Suzanne;
The Ideal Credentialing Standards: Best Practice Criteria and Protocol for Hospitals
The Ideal Credentialing Standards: Best Practice Criteria and Protocol for Hospitals Credentialing best practices include an evidence-based evaluation that verifies 13 specific criteria from primary sources.
PART II. LICENSURE BY CREDENTIALS
State of Alaska P.O. Box 110806, Juneau, Alaska 99811-0806 Telephone: (907) 465-2551 E-mail: license@alaska.gov Website: www.commerce.alaska.gov/occ BACCALAUREATE SOCIAL WORKER LICENSURE APPLICATION READ
Practitioner Profile General Information License Number:
Practitioner Profile General Information Primary Practice Address: (456.039 (1) (a) 3., F.S.) Medicaid: (456.039 (1) (b) (5) d., F.S.) Select Medicaid Statement: This practitioner does participate in the
HEALTH FIRST NETWORK, INC. CREDENTIALS PROGRAM AND POLICIES & PROCEDURES MANUAL
HEALTH FIRST NETWORK, INC. CREDENTIALS PROGRAM AND POLICIES & PROCEDURES MANUAL IMPLEMENTED: JUNE, 1995 REVIEWED: APRIL, MAY, 1996 REVISED: JUNE, 1996 REVISED: JUNE, 1997 REVISED: JUNE, 1998 REVISED: SEPTEMBER,
LIBERTY DENTAL PLAN Provider Credentialing Application
(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:
Credentials Policy Manual. Reviewed & Approved by MEC 8/13/2012 Reviewed & Approved by Board of Commissioners 9/11/12
Credentials Policy Manual Reviewed & Approved by MEC 8/13/2012 Reviewed & Approved by Board of Commissioners 9/11/12 Credentialing Policy Manual Table of Contents I. Application for Appointment to Staff...1
APPLYING FOR A MEDICAL LICENSE IN MICHIGAN
APPLYING FOR A MEDICAL LICENSE IN MICHIGAN TYPES OF LICENSES AVAILABLE Educational limited - to practice in teaching hospital under supervision Clinical academic to teach or do research in training program
UNITED BEHAVIORAL HEALTH. Clinician and Facility Credentialing Plan
UNITED BEHAVIORAL HEALTH Clinician and Facility Credentialing Plan 2014-2015 CREDENTIALING PLAN TABLE OF CONTENTS Section 1 INTRODUCTION... 1 Section 1.1 Purpose.... 1 Section 1.2 Discretion, Rights and
CREDENTIALING POLICY FOR ALLIED HEALTH PROFESSIONALS
CREDENTIALING POLICY FOR ALLIED HEALTH PROFESSIONALS TABLE OF CONTENTS Article Page 1 DEFINITIONS.. 1 2 SCOPE AND OVERVIEW OF POLICY 2.1 Scope of Policy 3 2.2 Classification of Allied Health Professionals..
Regulations Governing Licensure of Professional Art Therapists
Regulations Governing Licensure of Professional Art Therapists Mississippi State Department of Health Office of Licensure Professional Licensure Division P. O. Box 1700 Jackson, Mississippi 39215-1700
UPDATED. Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs
UPDATED Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs Issued May 8, 2013 Updated Special Advisory Bulletin on the Effect of Exclusion from Participation
Credentialing. Recruitment & Retention Best Practices Model, 2005 Credentialing 1
Credentialing Introduction Any healthcare entity involved in recruiting healthcare practitioners has heard of credentialing, but often it is a misunderstood concept and a neglected task. Many liability
LifeWays Operating Procedures
LifeWays Operating Procedures CHAPTER GOVERNING POLICY 10.00 Network Management 03 Credentialing SUBJECT: 02. Credentialing Application EFFECTIVE DATE: 10/01/1997 REVIEWED/REVISED: 01/05/2011 10-03.03
GRADUATE REGISTERED PHYSICIANS
REGULATION 37 GRADUATE REGISTERED PHYSICIANS Act 929 of 2015 codified in A.C.A. 17-95-901-917 ARKANSAS GRADUATE REGISTERED PHYSICIAN ACT I. Definitions. A. Graduate registered physician means an individual
Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals
Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services to Iowa Plan Medicaid members.
NORTH COUNTRY COMMUNITY MENTAL HEALTH NORTHERN AFFILIATION UTILIZATION MANAGEMENT PLAN November 1, 2001. Revised January 2013
NORTH COUNTRY COMMUNITY MENTAL HEALTH NORTHERN AFFILIATION UTILIZATION MANAGEMENT PLAN November 1, 2001 Revised January 2013 I. Mission II. III. IV. Scope Philosophy Authority V. Utilization Management
MGHS CREDENTIALS MANUAL
MGHS CREDENTIALS MANUAL POLICY FOR MEMBERSHIP TO THE MARQUETTE GENERAL HEALTH SYSTEM (MGHS) MEDICAL STAFF Applications for Medical Staff membership to MGHS shall be provided to physicians, dentists, podiatrists,
LOCUM TENENS APPLICATION Page 1 of 4
Page 1 of 4 This form is only valid for Locum Tenens providing coverage for up to 60 days. SECTION I PROVIDER INFORMATION This section to be completed by the PacificSource participating practitioner. Please
Standard HR.7 All individuals permitted by law and the organization to practice independently are appointed through a defined process.
Credentialing and Privileging of Licensed Independent Practitioners The following standards apply to individuals permitted by law and the organization to provide patient care services without direction
NURSE PRACTITIONER/PHYSICIANS ASSISTANT APPLICATION GENERAL INFORMATION. Last Name First Middle. Place of Birth Social Security #
Page 1 NURSE PRACTITIONER/PHYSICIANS ASSISTANT APPLICATION GENERAL INFORMATION Last Name First Middle Place of Birth Social Security # Home Address City State Zip Office Address City State Zip DOB Emergency
CHAPTER 152 SENATE BILL 1362 AN ACT
Senate Engrossed State of Arizona Senate Fiftieth Legislature Second Regular Session 0 CHAPTER SENATE BILL AN ACT AMENDING SECTION -0, ARIZONA REVISED STATUTES; AMENDING TITLE, CHAPTER, ARTICLE, ARIZONA
Anthem Credentialing Programs Standards
Anthem Credentialing Programs Standards A. Eligibility Criteria Health Care Practitioners Initial applicants must meet the following criteria in order to be considered for participation: 1. Possess a current,
To ensure that participating providers and physician executives meet basic qualifications before providing services to CenCal Health Members.
Policy #: 500-2010-I Title: Provider Credentialing Policy Dept.: Provider Services Effective Date: July 1 st, 2014 I. PURPOSE To ensure that participating providers and physician executives meet basic
ARKANSAS BOARD OF PODIATRIC MEDICINE
ARKANSAS BOARD OF PODIATRIC MEDICINE APPLICATION FOR LICENSE TO PRACTICE PODIATRIC MEDICINE 1. Name: Social Security Number: (As to appear on License) 2. Address: 3. Address you wish License to be mailed:
CLINICAL SOCIAL WORKER LICENSURE APPLICATION
P.O. Box 110806, Juneau, Alaska 99811-0806 Telephone: (907) 465-2551 E-mail: license@alaska.gov Website: www.commerce.alaska.gov/occ CLINICAL SOCIAL WORKER LICENSURE APPLICATION READ THESE INSTRUCTIONS
STATE BOARD OF PSYCHOLOGY
STATE BOARD OF PSYCHOLOGY Prohibits, beginning September 29, 2014, an individual from practicing applied behavior analysis in Ohio or holding the individual's self out to be a certified Ohio behavior analyst
CRAIG HOSPITAL ENGLEWOOD, COLORADO BYLAWS OF THE MEDICAL STAFF ADOPTED AS AMENDED: MARCH 26, 2015
CRAIG HOSPITAL ENGLEWOOD, COLORADO BYLAWS OF THE MEDICAL STAFF ADOPTED AS AMENDED: MARCH 26, 2015 BYLAWS OF THE MEDICAL STAFF 48355590.5 TABLE OF CONTENTS PAGE PREAMBLE... 1 DEFINITIONS...1 ARTICLE I.
NURSE SPECIALTY APPLICATION PACKET
Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services Board of Nursing PO Box 30193 Lansing, MI 48909 (517) 335-0918 Page 1 of 17 NURSE SPECIALTY APPLICATION PACKET INCLUDED
Board Marriage and Family Therapy
Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services Board of Marriage and Family Therapy PO Box 30670 Lansing MI 48909 (517) 335-0918 www.michigan.gov/healthlicense Page
UNIVERSITY OF NORTH CAROLINA HOSPITALS
7 1 BYLAWS OF THE MEDICAL STAFF UNIVERSITY OF NORTH CAROLINA HOSPITALS Approved by the Executive Committee of the Medical Staff, November 5, 2001. Approved by the Medical Staff, December 5, 2001. Approved
POLICY ON CREDENTIALING ALLIED HEALTH PROFESSIONALS MIDLAND MEMORIAL HOSPITAL. Midland, Texas 79701
POLICY ON CREDENTIALING ALLIED HEALTH PROFESSIONALS At MIDLAND MEMORIAL HOSPITAL Midland, Texas 79701 Date: April 2004 Revision: October 2009 Policy Tech Ref # : 5833 1 Approved: 02/14/2013 Last Reviewed:
Credentialing Program Plan Description
BLUE CROSS AND BLUE SHIELD OF KANSAS Credentialing Program Plan Description 1133 SW Topeka Boulevard Topeka, Kansas 66629-0001 Website: www.bcbsks.com Last Updated: March 20, 2015 Table of Contents OVERVIEW...
TITLE: Allied Health Professional Policy
TITLE: Allied Health Professional Policy Number: Version: Status: Current Type: Medical Staff Policy Author: Medical Staff Original Date: Revised Dates: Review Cycle: Triennial Deactivation Date: Facility:
Credentialing/Recredentialing
Introduction... 2 Overview... 2 Credentials Committee... 3 Credentialing Criteria... 4 Eligibility Criteria... 4 Additional Eligibility Criteria for All Applicants (Initial or Recredentialing)... 4 Recredentialing...
Section 5: Credentialing
Section 5: Credentialing PRACTITIONER CREDENTIALING CRITERIA...124 All Practitioners... 124 All Physicians... 125 Other Licensed Practitioners... 127 Unlicensed Practitioners... 127 Non-Credentialed Practitioners...
TENNESSEE DEPARTMENT OF HEALTH
TENNESSEE DEPARTMENT OF HEALTH MANDATORY PRACTITIONER PROFILE QUESTIONNAIRE FOR LICENSED HEALTH CARE PROVIDERS The Health Care Consumer Right-to-Know Act of 1998, T.C.A. 63-51-101, et seq., requires designated
D. Monitoring: A process utilized by Authority staff to systematically review the implementation and compliance of funded programs.
Abuse Disorder (SUD) Providers, Autism Spectrum Disorder Providers, Hospitals, Individuals (i.e., Physician (MD/DO), licensed clinicians, etc.) Services are provided via outpatient (ambulatory), residential
Allied Health Professional Rules and Regulations
Allied Health Professional Rules and Regulations I. Purpose To maintain an organized Allied Health Professional Staff committed to promoting effective delivery of patient services, and continuous review
6002 Credentialing Mental Health Screeners and Payment for Voluntary Admissions
6002 Credentialing Mental Health Screeners and Payment for Voluntary Admissions 1.0 Mental Health Screener Credentialing Title 16, Chapter 51 of the Delaware Code states that only psychiatrists and professionals
RULES AND REGULATIONS FOR LICENSING APPLIED BEHAVIOR ANALYSTS AND APPLIED BEHAVIOR ASSISTANT ANALYSTS
RULES AND REGULATIONS FOR LICENSING APPLIED BEHAVIOR ANALYSTS AND APPLIED BEHAVIOR ASSISTANT ANALYSTS [R5-86-ABA] STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH October 2015 INTRODUCTION
Board Respiratory Care
Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services Board of Respiratory Care PO Box 30670 Lansing MI 48909 (517) 335-0918 www.michigan.gov/healthlicense Page 1 of 14
PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE:
PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY/ PROCEDURE Policy/Procedure Title: Non-Physician Medical Practitioner Credentialing Criteria External Policy Reviewing IQI P & T QUAC Entities: OPERATIONS EXECUTIVE
Dental Initial Credentialing Application
Dental Initial Credentialing Application Practitioner and Practice Information Name(last) (First) (Middle) Degree Social Security Number Personal NPI Date of Birth Gender Practice Name Practice Taxpayer
Accountable Care Organization. Medicare Shared Savings Program. Compliance Plan
Accountable Care Organization Participating In The Medicare Shared Savings Program Compliance Plan 2014 Corporate Location: 3190 Fairview Park Drive Falls Church, VA 22042 ARTICLE I INTRODUCTION This Compliance
APPENDIX E. Summary of the Texas Physician Assistant Licensing Act. University of Texas Southwestern Medical Center June 2001
APPENDIX E Summary of the Texas Physician Assistant Licensing Act * Roderick S. Hooker, PhD University of Texas Southwestern Medical Center June 2001 Prepared for: The University of Texas Health Sciences
JAN 2 2 2016. Hawaii Revised Statutes regulates numerous professions and. occupations, including marriage and family therapists.
S.B. NO. JAN 0 A BILL FOR AN ACT THE SENATE TWENTY-EIGHTH LEGISLATURE, 0 STATE OF HAWAII RELATED TO LICENSED MARRIAGE AND FAMILY THERAPISTS. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: I 0
Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP)
Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP) 2014 Magellan Health Services Table of Contents SECTION 1: INTRODUCTION... 3 Welcome... 3 Covered
CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures.
CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures. 59A-23.004 Quality Assurance. 59A-23.005 Medical Records and