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COMMUNITY HEALTH PLAN

CREDENTIALING AND SITE CERTIFICATION

1.

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.

PROVIDER RELATIONS

1.

If approved, enters new provider data

from the

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 a part of the daily review process. If denied, notifies DHS Facility/Contract Liaison that the provider will not be added to the provider network.

2.

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

1.

Receives a (Attachment 3) from CHP DHS Facility/Contract Liaison.

2.

Reviews the for completeness and approves the form when complete. If change reflects a provider change of address, forwards to Credentialing and Site Certification for approval.

PROVIDER RELATIONS

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