Credentialing and Re. credentialing. Contractor shall credential Providers in accordance with NCQA credentialing standards as well as applicable HFS, DHS, IDoA, Illinois Department of Insurance, and federal requirements. Re‐ credentialing shall occur every three (3) years. At re‐credentialing and on a continuing basis, Contractor shall verify minimum credentialing requirements and monitor Enrollee Complaints and Appeals, quality‐of‐care and quality‐of‐ service events, and medical record review. Contractor shall document its process for credentialing and re‐credentialing Providers.
Appears in 2 contracts
Sources: State of Illinois Contract, State of Illinois Contract