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COMMUNITY HEALTH PLAN

1.

Receives new primary care site (PCS) and provider information from CHP DHS Facility/Contract Liaison.

2.

Reviews submitted request for completeness. Analyzes submittal according to business criteria which includes but is not limited to: a) the proposed PCS is within an appropriate distance of an affiliated hospital; b) the PCS improves access to services; c) the PCS is evaluated according to population/ geographic/cultural and linguistic/ and specialization needs; and d) all telephone numbers are verified by calling the listed number to validate that it is correct.

3.

Enters the provider information into Pending Provider File in Excel format. Prints out all information entered on a daily basis. Supervisor reviews a minimum of 20% of the provider information entered against the source documents to ensure accuracy. Necessary corrections are made as appropriate. Supervisor reviews corrected provider information to ensure all corrections have been made.

4.

If approved, forwards approved information to Credentialing and Site Certification for further analysis. If denied, notifies contractor that the site will not be added to the provider site network.

PROVIDER RELATIONS

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