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COMMUNITY HEALTH PLAN

1.

Receives the from Provider Relations.

2.

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

3.

If provider is an existing CHP Medi-Cal PCP, requests Medical Record Review score from L.A. Care. If PCP is new to CHP, requests a Medical Record Review from Quality Management.

NOTE: The Medical Record Review must meet L.A. Care s pass criteria. Status is pending until Quality Management notifies Credentialing and Site Certification of the passing Medical Record Review score.

1.

Upon request, conducts Medical Record Review. Forwards the Medical Record Review score to Credentialing and Site Certification.

CREDENTIALING AND SITE CERTIFICATION

CREDENTIALING AND SITE SITE CERTIFICATION

QUALITY MANAGEMENT

3.

When the request is to add a PCP, requests Medical Record Review score or a Medical Record Review of provider from L.A. Care.

NOTE: The Medical Record Review must meet L.A. Care s pass criteria. Status is pending until L.A. Care notifies CHP of the passing Medical Record Review score.

4.

Upon verification that the provider is credentialed and receipt of the Medical Record Review score for PCPs, indicates status on the and forwards to Provider Relations.

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