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COMMUNITY HEALTH PLAN

2.

Notifies Credentialing and Site Certification of the FSR score.

1.

Receives FSR score from an approved health plan or QM.

CREDENTIALING AND SITE CERTIFICATION

1.

Notifies Provider Relations of the FSR score and the results of analysis. If approved, provides written notice that the PCS and provider(s) is/are certified.

1.

If approved, enters new PCS information into Pending Provider File in Excel format to be included in the monthly upload file containing adds, deletes, and changes to the provider database. Updated data entered is reviewed as part of the daily review process. If denied, notifies the DHS/Facility Contract Liaison that the PCS will not be added to the provider site network.

2.

Forwards the monthly upload file to Information Systems to update the provider database. (SEE “UPDATING THE PROVIDER DATABASE,” page 11)

CREDENTIALING AND SITE CERTIFICATION

PROVIDER RELATIONS

PROVIDER RELATIONS

1.

Receives a (Attachment 1 or 2) requesting to add a primary care provider (PCP), specialty provider (SP), or mid-level provider (MLP)

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