Common use of Provider Credentialing Clause in Contracts

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:  Compliance with state record keeping requirements;  FSSA’s access and availability standards; and  Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to implement a centralized model for provider enrollment and credentialing. Upon implementation the Contractor shall accept the FSSA enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies established.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:  Compliance with state record keeping requirements;  FSSA’s access and availability standards; and  Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to will implement a centralized model for provider enrollment and credentialingcredentialing called FSSA EnCred (EnCred) in 2019 consistent with the provisions of IC 12-15-11-9. Upon implementation The State contracts with a certified Credentialing Verification Organization (CVO), which is an accredited credentialing entity, to perform enrollment and credentialing simultaneously for providers in all IHCP programs. Providers will utilize a single online application and submit required documentation through FSSA EnCred to enroll as a provider and become credentialed. The enrollment and credentialing decision will serve as the credentialing decision required for all subsequent MCE enrollment. The Contractor shall designate their Medical Director or another qualified designee, subject to State approval, to actively participate and vote in the FSSA Secretary’s EnCred Credentialing Advisory Committee. The Contractor shall accept the FSSA EnCred enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies establishedestablished for FSSA EnCred.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:  ▪ Compliance with state record keeping requirements;  ▪ FSSA’s access and availability standards; and  ▪ Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to will implement a centralized model for provider enrollment and credentialingcredentialing called FSSA EnCred (EnCred) in 2019 consistent with the provisions of IC 12-15-11-9. Upon implementation The State contracts with a certified Credentialing Verification Organization (CVO), which is an accredited credentialing entity, to perform enrollment and credentialing simultaneously for providers in all IHCP programs. Providers will utilize a single online application and submit required documentation through FSSA EnCred to enroll as a provider and become credentialed. The enrollment and credentialing decision will serve as the credentialing decision required for all subsequent MCE enrollment. The Contractor shall designate their Medical Director or another qualified designee, subject to State approval, to actively participate and vote in the FSSA Secretary’s EnCred Credentialing Advisory Committee. The Contractor shall accept the FSSA EnCred enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies establishedestablished for FSSA EnCred.

Provider Credentialing. The Contractor shall must have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-re- credentialing process for all contracted providers shall must meet the National Committee for Quality Assurance (NCQA) NCQA guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPPFSSA’s standard provider credentialing form during the credentialing process. A copy of this form is provided in the Bidder’s Library. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:   Compliance with state record keeping requirements;   FSSA’s access and availability standards; and   Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall must not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPPFSSA, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to implement a centralized model for provider enrollment and credentialing. Upon implementation the Contractor shall accept the FSSA enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies established.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-re- credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must shall apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must shall ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:   Compliance with state record keeping requirements;   FSSA’s access and availability standards; and   Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to implement a centralized model for provider enrollment and credentialing. Upon implementation the Contractor shall accept the FSSA enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies established.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:  Compliance with state record keeping requirements;  FSSA’s access and availability standards; and  Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to will implement a centralized model for provider enrollment and credentialingcredentialing called FSSA EnCred (EnCred) in 2019 consistent with the provisions of IC 12-15-11-9. Upon implementation The State contracts with a certified Credentialing Verification Organization (CVO), which is an accredited credentialing entity, to perform enrollment and credentialing simultaneously for providers in all IHCP programs. Providers will utilize a single online application and submit required documentation through FSSA EnCred to enroll as a provider and become credentialed. The enrollment and credentialing decision will serve as the credentialing decision required for all subsequent MCE enrollment. The Contractor shall designate their Medical Director or another qualified designee, subject to State approval, to actively Contractor shall accept the FSSA EnCred enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies establishedestablished for FSSA EnCred.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:  ▪ Compliance with state record keeping requirements;  ▪ FSSA’s access and availability standards; and  ▪ Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to implement a centralized model for provider enrollment and credentialing. Upon implementation the Contractor shall accept the FSSA enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies established.

Provider Credentialing. The Contractor shall have written credentialing and re-credentialing policies and procedures for ensuring quality of care is maintained or improved and assuring that all contracted providers hold current state licensure and enrollment in the IHCP. The Contractor’s credentialing and re-re- credentialing process for all contracted providers shall meet the National Committee for Quality Assurance (NCQA) guidelines. The same provider credentialing standards must apply across all Indiana Medicaid programs. The Contractor shall use OMPP’s standard provider credentialing form during the credentialing process. The Contractor must ensure that providers agree to meet all of FSSA’s and the Contractor’s standards for credentialing PMPs and specialists, and maintain IHCP manual standards, including:   Compliance with state record keeping requirements;   FSSA’s access and availability standards; and   Other quality improvement program standards. As provided in 42 CFR 438.214(c), which prevents discrimination in provider selection, the Contractor’s provider credentialing and selection policies shall not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costly treatment. The Contractor shall not employ or contract with providers that have been excluded from participating in federal health care programs under Section 1128 or Section 1128A of the Social Security Act. The Contractor shall notify OMPP, in the manner prescribed by the State, of any credentialing applications that are denied due to program integrity related reasons. The Contractor shall process all credentialing applications within thirty (30) calendar days of receipt of a complete application. If the Contractor delegates credentialing functions to a delegated credentialing agency, the Contractor shall ensure all credentialed providers are loaded into the Contractor’s provider files and claims system within fifteen (15) calendar days of receipt from the delegated entity. The contractors credentialing and recredentialing process, policies and procedures must be demonstrated in readiness review. The State intends to implement a centralized model for provider enrollment and credentialing. Upon implementation the Contractor shall accept the FSSA enrollment and credentialing determinations as final. The Contractor shall not require providers to submit supplemental information for purposes of conducting an additional credentialing process. Contractor may not add credentialing requirements to the contracting process, or delay contracting with a provider consistent with IC 12-15-11-9(b). The Contractor shall continue to retain final decision making responsibilities with respect to provider contracts and network design, subject to other requirements of this Contract including but not limited to network adequacy. The Contractor shall comply with all rules, regulations, and policies established.