Delegated Credentialing Sample Clauses

Delegated Credentialing. The FIDA Plan may subcontract or delegate all or part of its credentialing functions when the First Tier or Downstream Entity, such as a Participating Provider organization, maintains a formal credentialing program in compliance with the FIDA Plan, NCQA, CMS, NYSDOH and applicable regulatory standards. The FIDA Plan shall remain responsible for delegated Participating Provider credentialing and re-credentialing.

Delegated Credentialing. The contract between the Department and the MCOs permits the plan to delegate credentialing of individual providers to a facility. However, the MCO is ultimately responsible and accountable to DSS for compliance with the Department's credentialing requirements. For the purpose of HUSKY, delegated credentialing means that the MCO entrusts the Department's credentialing requirements to another entity. MCOs delegate credentialing to a variety of entities depending on the nature of the services and the type of provider. In delegated credentialing, the MCO remains responsible to DSS to verify and monitor compliance with the Department's credentialing requirements. The Department views delegated credentialing as a form of subcontract, therefore, similar oversight issues arise in the performance of the credentialing requirements. The Department requires the plans to demonstrate and document to DSS the plan's strong oversight of its delegated credentialing facilities. (Part II, Section 3.41 in B 3.44 in A, Subcontracting for Services).

Delegated Credentialing. For contractors who delegate credentialing, the credentialing subcontractor must meet the requirements of Paragraphs 2.12.4.1 and 2.12.4.2 of this contract. The contractors Credentialing Committee must review and approve or disapprove providers submitted by the delegated credentialing provider. The contractor will monitor the delegated credentialing provider at least annually to ensure compliance with Paragraphs 2.12.4.1 and 2.12.4.2. (1) Provide for prompt submission of information needed to make payment. (2) Make full disclosure of the method and amount of compensation or other consideration to be received from the contractor. The provider must not charge for any service provided to the recipient at a rate in excess of the rates established by the contract in accordance with Section 1128B(d)(1), Social Security Act (enacted by Section 4704 of the Balanced Budget Act of 1997). The provider may not ▇▇▇▇ the recipient any amount greater than would be owed if the entity provided the services directly. (3) Require an adequate record system be maintained for recording services, charges, dates and all other commonly accepted information elements for services rendered to recipients.

Delegated Credentialing. ReCredentialing. Anthem BC&BS reserves the right to require CONTRACTING PROVIDER to conduct Credentialing and/or ReCredentialing upon ninety (90) days prior written notice to CONTRACTING PROVIDER. CONTRACTING PROVIDER shall perform any such Credentialing and ReCredentialing in compliance with Anthem BC&BS requirements and otherwise in accordance with accreditation standards related thereto of the National Committee for Quality Assurance ("NCQA").

Delegated Credentialing. Contractor may subcontract all or part of its credentialing functions when the subcontractor, such as a Provider organization, maintains a formal credentialing program in compliance with Contractor, NCQA, the Department, and applicable regulatory agency standards. Contractor shall remain responsible for Provider credentialing and re-credentialing. Verification of qualifications of Providers of Covered Services under HCBS Waivers. Contractor shall ensure that only those Providers that are approved and authorized by the Department are providing Covered Services under HCBS Waivers, and that those Providers are providing to Enrollees only Covered Services for which they are approved and authorized. The Department will provide Contractor with a weekly Department extract file containing the list of such approved and authorized Providers. Contractor is not required to credential Providers of Covered Services under HCBS Waivers.‌ Department Credentials Verification Organization (CVO). The Department may require Contractor to delegate credentialing services to a CVO identified by the Department. The Department shall provide at least ninety (90) days’ notice, in writing, of this change. The Department retains the right to define the scope of services required to be provided by such a CVO.

Delegated Credentialing. Contractor may delegate Credentialing and recredentialing activities but shall monitor the completion and effectiveness of the delegated process. If Contractor delegates Credentialing and recredentialing activities, Contractor shall implement and maintain policies and procedures which delineate the delegated activities and responsibility for these activities.

Delegated Credentialing. (1) For Contractors who delegate credentialing, the credentialing subcontractor must meet the requirements of this ATTACHMENT I, sections 2.12.4.1 and 2.12.4.2. (2) The Contractors Credentialing Committee must review and approve or disapprove providers submitted by the delegated credentialing provider. (3) The Contractor shall monitor the delegated credentialing provider at least annually to ensure compliance with this ATTACHMENT I, sections 2.12.4.1 and 2.12.4.2.

Delegated Credentialing. The Contractor will ensure the qualifications of all network practitioners, approve new providers and sites, and terminate or suspend individual providers. The Contractor may delegate Credentialing and recredentialing activities but will monitor the completion and effectiveness of the delegated process, If the Contractor delegates Credentialing and recredentialing activities, the Contractor will implement and maintain policies and procedures which delineate the delegated activities and responsibility for these activities.