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COMMUNITY HEALTH PLAN

to an existing site from a 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 provider is within an appropriate distance of an affiliated hospital; b) adding the provider improves access to services; c) adding the provider meets 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.

If approved, forwards approved information to Credentialing and Site Certification for further analysis. If denied, notifies the DHS/Facility Contract Liaison that the provider will not be added to the provider network.

4.

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.

PROVIDER RELATIONS

1.

Receives the from Provider Relations.

2.

When applicable, obtains documented verification of credentialing and of license.

CREDENTIALING AND SITE CERTIFICATION

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