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COMMUNITY HEALTH PLAN

1.

Receives new PCS information and provider information from Provider Relations.

2.

Obtains documented verification of credentialing and verification of license.

3.

Requests site certification of DHS Facility/Contractor from L.A. Care.

1.

Obtains Facility Site Review (FSR) score from files or conducts FSR of DHS Facility/Contract site. The FSR Score must be at least 80% for approval.

2.

Notifies Credentialing and Site Certification of the FSR score.

1.

Receives FSR score from L.A. Care. NOTE: The FSR score must meet L.A. Care s pass criteria. The FSR score must be at least 80%.

CREDENTIALING AND SITE CERTIFICATION

L.A. CARE

CREDENTIALING AND SITE CERTIFICATION

1.

Receives new PCS information and provider information from Provider Relations.

2.

Obtains documented verification of credentialing and verification of license.

3.

Researches site certification score of DHS Facility/Contract site from an approved health plan or requests that Quality Management (QM) conduct a FSR.

1.

If an approved FSR score is not available from an approved health plan, conducts FSR of DHS Facility/Contract site.

CREDENTIALING AND SITE CERTIFICATION

QUALITY MANAGEMENT

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