Credentialing Requirements for Physicians & Facilities
|
|
|
- Charla Lyons
- 10 years ago
- Views:
Transcription
1 Credentialing Requirements for Physicians & Facilities
2 Thank you for attending! Welcome to Geisinger Health Plan s online learning center. We appreciate your time attending and welcome your feedback. After attending the learning center, you will receive a electronic survey. Please provide your feedback to ensure we continue to meet your needs.
3 Objective At the end of this presentation, you will have insight into the relevant credentialing requirements needed to participate with Geisinger Health Plan, including how to use the CAQH application process.
4 Agenda Reasons why managed care payor credential providers Initial Screening Criteria CAQH Application Process Recredentialing Process and Time Line Other Providers Credentialed Submission of provider changes, including demographic, or expansion of location and/or services
5 Reason we Credential Credentialing is the process by which we review and validate the professional qualifications of physicians and certain other providers who apply for participation with Geisinger Health Plan. Regulatory bodies, such as NCQA, DOH and CMS require managed care organizations to complete a thorough review of it s provider network providers. Standards are establish to allow members access to high quality providers. Credentialing is also used in our fraud, waste and abuse program to mitigate our stake holders exposure to inappropriate and/or illegal situations.
6 Initial Credentialing Criteria A post-secondary education degree and, if applicable, post graduate training appropriate to your specialty Current, unrestricted license(s) to practice the practitioner's specialty(ies); Current Drug Enforcement Agency certificate, if applicable Current certificate of insurance indicating professional liability insurance coverage (state licensure board minimum required limits) For M.D./D.O.s, board certification or proof of board eligibility in practicing specialty
7 Initial Credentialing Criteria Obtain and maintain hospital admitting/surgical privileges at a Geisinger Health Plan participating hospital provider. To join as a PCP, 50% of you time is attributed to the practice of medicine, with a minimum of 20 hours a week available to your patients Clinical practice of medicine should be in general practice, family practice, general internal medicine and/or general pediatrics for at least 2 years prior to applying to the Geisinger Health Plan to become a PCP. For questions on additional criteria contact the Credentialing Department at
8 Practitioners Credentialed Practitioners with clean and complete information are commonly processed within 60 days or less. Medical Doctors (M.D.) Doctors of Osteopathy (D.O.) Chiropractors (D.C.) Dentists/Oral Surgeons (D.D.S./D.M.D.) Optometrists (O.D.) Podiatrists (D.P.M.) Certified Nurse Midwives (C.N.M.)
9 Credentialing is NOT required Locum Tenens with less than 6 months Nurse Practitioner, Physicians Assistants or Residents Geisinger Health Plan does not reimburse for services billed under Nurse Practitioners, Physician Assistants or Residents. Services should be reported using the incident to guidelines.
10 Initial Credentialing Process Who Practitioner Facility Geisinger Health Plan Geisinger Health Plan Action Required Complete a CAQH Application Complete Geisinger Health Plan s Facility Application Will verify Practitioner or Facility against criteria and approve or deny Will send a Welcome letter to approved Practitioners upon approval by Committee (Normal processing time is less than 8 weeks)
11 CAQH Practitioner Application Effective January 1, 2011, we require a CAQH application only for practitioners It s free, easy and secure Visit [email protected] Or, call CAQH Help Desk at Or, fax CAQH at Reminder: Give Geisinger Health Plan access to your applications orial/1747_caqh.html
12 CAQH Getting Started All GHP providers must have a CAQH Provider ID to register and begin the credentialing process. First time users 1. If you are not registered with CAQH and are a first-time user, when you apply for participation, GHP will add your name to its CAQH roster. CAQH will mail you access and registration instructions, along with your personal CAQH Provider ID, allowing you to obtain immediate access to the UPD via the Internet. 2. When you receive your CAQH Provider ID, go to the CAQH website to register. After successfully authenticating key information you will be able to create your own user name and unique password to begin using the UPD database. Once registration is completed, you may use your user name and password to log in at any time.
13 CAQH Application Process Completing the Application Process The UPD standardized application is a single, standard online form that meets the needs of all participating health care organizations. When completing the application, you will indicate which participating health plans and health care organizations you authorize to access your application data. All provider data you submit through the UPD service is maintained by CAQH in a secure, state-of-the-art data center. When you are ready to begin entering your data, log in to the CAQH website with your user name and password.
14 CAQH Required Materials Materials that will be helpful while completing the application: Previously completed credentialing application (for reference) List of previous and current practice locations Various identification numbers (UPIN, NPI, Medicare, Medicaid etc) State medical license(s) Curriculum Vitae Drug Enforcement Administration (DEA) Certificate Controlled and Dangerous Substances (CDS) Certificate IRS Form W-9(s) Malpractice insurance face sheet Summary of any pending or settled malpractice cases
15 CAQH Process Complete After completing the online credentialing application, you will also be asked to: 1. Authorize access to your information List organizations that you would like to receive your information (confirm DOH or specific plan listing) 2. Verify your data entry/attest Review a summary of your data for completeness, and make any changes as necessary 3. Submit supporting documents Fax the documents required to complete your application to CAQH at (866) If you have any questions on accessing the UPD (hyperlink)database, you may contact the CAQH Help Desk at (888) for assistance.
16 CAQH - Recredentialing CAQH requires you to review and attest to your data once every 3 months. At the time you are scheduled for recredentialing, GHP will send your name to CAQH to determine if you have already completed the UPD credentialing process. If so, we will be able to obtain current information from the UPD database and complete the recredentialing process without having to contact you. The process of recredentialing is identical to that for initial credentialing, and is consistent with NCQA and State of PA requirements. If your application is not available to GHP, you will be added to our roster and CAQH will send you a registration letter and CAQH Provider ID so that you can complete the UPD credentialing process. This will help you continue to conform to the requirements of your PA DOH contract.
17 PA Standard Application By exception, we will accept a PA Standard Application This may extend the processing time Mail to: Geisinger Health Plan, 100 North Academy Avenue, Danville PA Attn: Credentialing Fax to: to: [email protected] Questions: By Exception only
18 Other Providers Credentialed Audiology PT/OT/ST (Rehab) DME Prosthetic/Orthotic Hospitals Skilled Nursing Facilities Ambulatory Surgical Centers Home Health Agency Hospice Agency Dialysis Laboratory Radiology Urgent/Convenient Care Ambulance
19 Other Providers Application A separate application is appreciated for each location. This will ensure we gather data elements for each location. CAQH can not be used for facility enrollment
20 Other Providers Recredentialing Geisinger Health Plan recredentials every organizational providers every three (3) years based on initial credentialing date Geisinger will forward your recredentialing packet 6 months prior to dead line Completed information should be returned to
21 Important Changes Requiring Notification PCP limitations (age/practice/hours) New practice location New services offered (I.e., radiology, therapy, etc.) Provider resignation or relocation Change of contract (I.e., acquisition) Change of payment address Changes can impact members, payment and provider satisfaction
22 Important Changes Requiring Notification Changes/updates should be received prospectively. We appreciate a minimum of 30 days written notification. Include the effective date Practices changes made at CAQH (I.e., address, phone numbers, new practitioners, etc.) are accepted. Reminder: Give Geisinger Health Plan access to your information Forward changes, such as acquisitions, resignations, relocations, expansion of services, tax identification number, or demographics in writing to your Provider Relations Representative. Include Copy of W9 and designate who will assume AR
23 Key Credentialing Contacts For assistance with: Credentialing requirements & process CAQH Credentialing Application Contact: Geisinger Health Plan at or Help Desk: New Only:
24 Contact Provider Relations Team Seana Juda Marian Serafin Mary Ann Chmielewski n.com Lisa Samsel Maryann Feudale Taunda Snyder Kimberly Adler-Morelli Cathy Polinchok m x x Jan Goodeluinas m John Wietry Maryann Camacci m Denise Emig, Manager
25 Thank you for attending! Questions? Thank you for attending the online learning lab of Geisinger Health Plan. We appreciate your time attending and welcome your feedback. After attending the learning lab, you will receive a survey, which we appreciate your responses.
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...
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/Recredentialing
Credentialing/Recredentialing Section F-1 Credentialing Practitioner Credentialing Molina Healthcare of New Mexico, Inc. (Molina Healthcare) credentials practitioners/providers in accordance with internal
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
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
Type of Facility (As listed on License or Accreditation) Facility Demographics. Legal Business Name (as reported to the IRS):
Facility Credentialing and Recredentialing Application Please complete each section leaving no blank spaces. Clearly state if information requested is not applicable. Attach additional sheets when necessary.
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:
December, 1999. Dear Health Care Professional:
December, 1999 Dear Health Care Professional: In 1998, the Oklahoma Legislature passed a law dealing with credentials verification. That law directed the Board of Health to promulgate rules and the Oklahoma
Uniform Credentialing Application
Uniform Credentialing Application 63 O.S. Supp. 1998, Section 1-106.2 This form must be completed in full and typed or printed legibly (i.e. do not state see CV ). Write N/A in areas that do not apply
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
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
Credentialing and Privileging. Mary Coffey, MBA, RN Executive Director, Kenosha Community Health Center
Credentialing and Privileging Mary Coffey, MBA, RN Executive Director, Kenosha Community Health Center 1 The goal of this Continuing Education Program is to provide health care professionals with information
Section 4: Physicians and Providers
Section 4: Physicians and Providers 4.1 Eligible Providers The following physicians and practitioners are eligible to be considered as PacificSource participating providers, provided they meet credentialing
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
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,
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
NEIGHBORHOOD HEALTH PLAN OFRHODE ISLAND CREDENTIALING PRACTITIONER APPLICATION
NEIGHBORHOOD HEALTH PLAN OFRHODE ISLAND CREDENTIALING PRACTITIONER APPLICATION Neighborhood accepts the Council for Affordable Quality Healthcare (CAQH) application in lieu of Neighborhood s standard credentialing
Sagamore Health Network, Inc Provider Reference Manual. Physicians, Hospitals, Ancillaries, & Other Healthcare Professionals
Sagamore Health Network, Inc Provider Reference Manual Physicians, Hospitals, Ancillaries, & Other Healthcare Professionals Table of Contents Introduction...3 Contact Information...4 Sagamore Logo Definitions...5
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
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
FLORIDA BLUE HOSPITAL, ANCILLARY FACILITY AND SUPPLIER BUSINESS APPLICATION. Facility Name: Legal Name (if different from above):
FLORIDA BLUE HOSPITAL, ANCILLARY FACILITY AND SUPPLIER BUSINESS APPLICATION Florida Blue Provider Number: Facility Name: Legal Name (if different from above): Facility Physical Address: City: State: Zip
A. Clearly print or type information in each block. Complete each section entirely, indicate NOT APPLICABLE (N/A) where necessary.
Provider Application For use by Physicians and Independent Health Care Professionals BCBSF Provider Number: HCFA UPIN #: NPI #: PURPOSE: This Provider Application will be used for assigning a provider
4123-6-02.2 Provider access to the HPP - provider credentialing criteria.
4123-6-02.2 Provider access to the HPP - provider credentialing criteria. (A) The bureau shall establish minimum credentialing criteria for provider certification. Providers must meet all licensing, certification,
PHYSICIAN APPLICATION FOR EMPLOYMENT
PLEASE COMPLETE The Following. DATE Name Last First Middle Maiden Address City State Zip Date of Birth Place of Birth Social Security Number US Citizen Home Phone Email Address Specialty/Sub-specialty
Clinician Add/Change Application Form
Clinician Add/Change Application Form INSTRUCTIONS (1) Before completing this form, it is essential to review your current demographic information online to ensure that the requested changes align with
Medicare Beneficiaries (QMB) Provider Enrollment Application
Iowa Department of Human Services Medicare Beneficiaries (QMB) Provider Enrollment Application Please copy and complete one for each individual professional and institutional category that is part of this
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
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
Credentialing and Contracting Instructions
Credentialing and Contracting Instructions What s required? All Dentists who want to enroll with DentaQuest must be credentialed AND contracted before you can begin treating members. To get credentialed
Table of Contents. 2 P a g e
Table of Contents Introduction... 3 Important Contact Information... 3 Pharmacy Rights... 3 Claims Adjudication... 3 Reversals... 4 Required Data Fields... 4 Identification cards... 4 Required Identification
CAQH ProView. Practice Manager Module User Guide
CAQH ProView Practice Manager Module User Guide Table of Contents Chapter 1: Introduction... 1 CAQH ProView Overview... 1 System Security... 2 Chapter 2: Registration... 3 Existing Practice Managers...
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
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
PHYSICIAN EXTENDER APPLICATION
An Independent Licensee of the Blue Cross and Blue Shield Association PHYSICIAN EXTENDER APPLICATION Instructions: Please PRINT or TYPE a response for each question. Please attach the copies of the documents
Review of Credentialing Systems: Supplemental Information and ECRI Institute Resources
Review of Credentialing Systems: Supplemental Information and ECRI Institute Resources HRSA Clinical Risk Management Resources Homepage Before You Fill Out the Application Have the following items with
Last Name First Middle
P.O. Box 327 Seattle, WA 98111-0327 DENTAL PROVIDER CREDENTIALING APPLICATION This application is not a contract. The information provided in this application is used to determine whether a practitioner
ONE CALL MEDICAL INC. NEURODIAGNOSTIC PHYSICIAN APPLICATION
ONE CALL MEDICAL INC. NEURODIAGNOSTIC PHYSICIAN APPLICATION Provider has the right to review information submitted to support credentialing, correct erroneous information, to be informed of application
INTRODUCTION. The Workers Compensation Act provides in part as follows:
INTRODUCTION The Maryland Workers Compensation Commission (Commission) amended COMAR 14.09.03.01 (Guide of Medical and Surgical Fees) on February 12, 2004. AUTHORITY The Workers Compensation Act provides
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
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:
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,
Mental Health/Substance Abuse Provider Orientation
Mental Health/Substance Abuse Provider Orientation Blue Cross Blue Shield of Vermont (BCBSVT) Welcome to Blue Cross Blue Shield of Vermont Our Vision A transformed health system in which every Vermonter
Greensboro, NC October 4-5, 2012. North Carolina Health Insurance Institute
Greensboro, NC October 4-5, 2012 North Carolina Health Insurance Institute About MedCost Over 29 years of experience providing employers throughout the Carolinas with the best access to the best health
Independent Contractor Information CRNA
Dear Provider: Thank you for your interest in Locum Leaders, your premier locum tenens agency. Locum Leaders provides A++ rated occurrence malpractice insurance through Med Pro. Please complete this entire
Mississippi Medicaid Enrollment Application (Ordering/Referring/Prescribing Provider)
This application is for the sole purpose of ordering/referring/prescribing items and services for MS Medicaid beneficiaries. This type of enrollment does not allow MS Medicaid to reimburse the applicant/provider
Rehab Net of Arkansas. Provider Application
Rehab Net of Arkansas Provider Application Discipline P.T. O.T. S.L.P. (1) Business Name Physical Address FACILITY DATA Phone Fax (2) Billing Address Phone Fax (3) Mailing Address (4) Owner/Contact Person
Credentialing, 855 Forms and NPI for Community Health Centers
Credentialing, 855 Forms and NPI for Community Health Centers National Association of Community Health Centers (NACHC) 7200 Wisconsin Avenue, Suite 210 Bethesda, MD 20814 301-347-0400 301-347-0459 FAX
Credentialing Program Description. Policy Update 7/8/2015
Credentialing Program Description Policy Update 7/8/2015 TABLE OF CONTENTS TABLE OF CONTENTS Executive Summary: Credentialing Program Description... 3 Definitions... 4 Authority and Responsibility for
There are some specific guidelines provided in the rules and regulations for these lists:
Health Care Provider Panels List Defined The PA Workers' Compensation Act gives employers the right to establish a list of designated health care providers. When the list is properly posted, injured workers
Departmental Policy. Nurse Credentialing and the Nurse Credentialing Committee
Page 1 of 6 Nurse Credentialing and the POLICY STATEMENT To describe the procedure for credentialing and privileging of Advanced Practice Nurses (APRNs), nurses in expanded roles, and non-hospital employed
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
Surgical Center of Greensboro/Orthopaedic Surgical Center Div of Surgical Care Affiliates
Allied Health Staff Application Instructions We are pleased to provide you with our Allied Health Staff application packet. Please do not write see attached or see resume or CV on the application. All
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: [email protected]
WELCOME! C. Wayne Ray, MD President, Medical Staff. Page 1 of 6
Medical Staff Services 12401 Washington Blvd. Whittier, CA 90602-1006 T: 562.698.0811 Ext. 13632 F: 562.789.4365 E: [email protected] WELCOME! Thank you for your interest in PIH Health Hospital - Whittier.
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
Why is doctor credentialing important to Aetna members? What does the Aetna doctor credentialing process involve?
Medical Credentialing What is doctor credentialing? Why is doctor credentialing important to Aetna members? What does the Aetna doctor credentialing process involve? What are the results of Aetna's commitment
CREDENTIALING APPLICATION PACKET INSTRUCTIONS
CREDENTIALING APPLICATION PACKET INSTRUCTIONS 1) If you would like to register with CAQH, please see the CAQH brochure enclosed (entitled: Introducing Universal Credentialing Data Source ) for more information
Hospital/Facility Provider Application
Hospital/Facility Provider Application Instructions: In order for the application to be considered complete: 1. All information must be legible. Please print or type all information. 2. A separate application
INSTRUCTIONS FOR ENROLLMENT AND CREDENTIALING WITH HOOSIER HEALTHWISE (HHW), HEALTHY INDIANA PLAN (HIP) AND CARE SELECT MANAGED CARE ENTITIES
INSTRUCTIONS FOR ENROLLMENT AND CREDENTIALING WITH HOOSIER HEALTHWISE (HHW), HEALTHY INDIANA PLAN (HIP) AND CARE SELECT MANAGED CARE ENTITIES To reduce the need for practitioners to complete multiple enrollment
SECTION 11: CREDENTIALING MVPHEALTH CAREPROVIDERRESOURCEMANUAL
SECTION 11: CREDENTIALING MVPHEALTH CAREPROVIDERRESOURCEMANUAL Review of Practitioner Credentialing and Recredentialing Information MVP will execute a participation agreement and complete the initial credentialing
CHAPTER 600 PROVIDER QUALIFICATIONS AND PROVIDER REQUIREMENTS 600 CHAPTER OVERVIEW... 600-1 610 AHCCCS PROVIDER QUALIFICATIONS...
600 CHAPTER OVERVIEW... 600-1 REFERENCES... 600-2 610 AHCCCS PROVIDER QUALIFICATIONS... 610-1 EXHIBIT 610-1 AHCCCS PROVIDER TYPES 620 AHCCCS FFS MINIMUM NETWORK REQUIREMENTS... 620-1 630 MEDICAL RECORD
CAQH ProView. Provider User Guide
CAQH ProView Provider User Guide Table of Contents CHAPTER 1: Introduction... 1 CAQH ProView Overview... 1 Getting Started... 1 System Security... 2 CHAPTER 2: Registration... 3 New Users... 3 Existing
Getting Started With. Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Information for Provider and Supplier Organizations
Getting Started With Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Information for Provider and Supplier Organizations June 1, 2009 The Centers for Medicare & Medicaid Services
The University of Utah Health Plans offers the following plans and networks. Please specify the networks you are interested in participating with:
Provider Networks Provider Applicant Process University of Utah Health Plans (UUHP) contracts with physicians and other health care professionals and facilities to offer provider networks essential to
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
Eligible Professional s Checklist 2015 Modified Stage 2 Meaningful Use
This checklist provides a look into Ohio s Medicaid Provider Incentive Program (MPIP) system for eligible professionals and may be used as a guide to help eligible professionals gather information that
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,
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
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
Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type
Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type Ohio Department of Job and Family Services TABLE OF CONTENTS General Instructions...3 Provider Enrollment Application Checklist: Individual
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...
M. Please itemize your historical visits (all) for the past five (5) years; and number of expected visits for this year.
ED GROUP APPLICATION FOR CLAIMS-MADE PROFESSIONAL LIABILITY INSURANCE Please note you are applying for a claims-made policy form of professional liability insurance. The coverage of this policy is limited
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
Health Reimbursement Arrangement (HRA) A Member Guide
Health Reimbursement Arrangement (HRA) A Member Guide 1 Table of Contents Maximize your healthcare dollars with an HRA through BCBSRI...3 How to pay your medical expenses... 4-5 Online portal instructions
Nurse Practitioners and Physician Assistants as Billing Providers
Office of Origin: UCSF Clinical Enterprise Compliance Program I. PURPOSE To establish guidelines for UCSF Nurse Practitioners (NP) and Physician Assistants (PA) to bill Medicare, Medi-Cal and other payors
HealthCare Administrative Solutions, Inc. Credentialing Manual
HealthCare Administrative Solutions, Inc. Credentialing Manual HCAS 2013 Disclaimer This manual is intended to provide general information about provider credentialing procedures. The information contained
AMA founded in 1847. U.S. Medical care highly regulated. Medical Doctor? Scope of Practice in the United States
Scope of Practice in the United States AMA founded in 1847 World Health Professions Conference on Regulation Michael D. Maves, MD, MBA Chief Executive Officer and EVP American Medical Association February
BEST PRACTICES FOR MEDICARE
BEST PRACTICES FOR MEDICARE AND MEDICAID EMR INCENTIVE PROGRAMS 1 Regina Gurvich, MBA CHC Chief Compliance Officer, AdvantageCare Physicians Monitoring compliance with Meaningful Use requirements Audit-ready
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
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:
NY State Medicaid Meaningful Use Registration & Attestation
NY State Medicaid Meaningful Use Registration & Attestation Developed & Co-Presented by CHCANYS & HCNNY Lisa Perry, Sandy Worden, Stephanie Rose, Desiree Railine, Jenna Cooper February 7, 2012 Our Goals
Application for Admission to the New Mexico Patients Compensation Fund
Application for Admission to the New Mexico Patients Compensation Fund This application will aid our determination of the appropriate terms of coverage in the New Mexico Patients Compensation Fund (NMPCF)
Review. Credentialing. for network providers
SUMMER/FALL 2007 2007 Credentialing Review for network providers Highmark Blue Shield endeavors to keep network practitioners and providers informed about network credentialing policies and procedures.
ENCLOSED IS THE FORM NECESSARY FOR SUBSTITUTE PHYSICIAN (LOCUM TENENS) COVERAGE
ENCLOSED IS THE FORM NECESSARY FOR SUBSTITUTE PHYSICIAN (LOCUM TENENS) COVERAGE You must be a licensed physician in Texas. Complete and sign the Application for Coverage. Complete the Claim/Suit Information
North Carolina Department of Insurance. Uniform Application. To Participate as a Health Care Practitioner
orth Carolina Department of Insurance Uniform Application To Participate as a Health Care Practitioner ote: Please send completed applications directly to the organizations with which you seek to contract.