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COMMUNITY HEALTH PLAN

3.

If change reflects provider change of address to a new service site, follow procedures in

1.

Approves or denies the and forwards it to Provider Relations.

1.

If approved, enters the change of information into the Change of Information file to be included in the monthly upload file containing adds, deletes, and changes to the provider database. If denied or additional clarification is required, notifies the DHS Facility/Contract Liaison.

2.

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

3.

Faxes copy of the Change of Information Form to Information Systems.

4.

Provides Members Services with a copy of the Change of Information Form.

5.

Retains completed and file for the record.

CREDENTIALING AND SITE CERTIFICATION

PROVIDER RELATIONS

PROVIDER RELATIONS

CHP DHS FACILITY LIAISON/ CONTRACT LIAISON

1.

Completes and faxes, or submits electronically the to CHP Provider Relations.

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