-Network Management

Provider Manual Home Page

NETWORK MANAGEMENT

Includes: Provider Network Membership; Provider Network Contract Management; Provider Network Credentialing; Provider Relations; Accreditation Requirements. Updated 12/07/18

Provider Network Policies & Procedures:

10-01 Provider Network Membership

      10-01.01 Provider Manual

      10-01.02 Procurement of Provided Services

      10-01.03 Network Development & Capacity Evaluation

10-02 Provider Network Contract Management

      10-02.01 Auditing Certification and Accreditation

      10-02.02 County of Financial Responsibility (COFR)

      10-02.03 Out of Network Contracting

      10-02.04 Delegated Managed Care Functions

      10-02.05 Provider Communications

      10-02.06 Provider Network Contract Development and Distribution

      10-02.07 Environment of Care Standards

10-03 Provider Network Credentialing

      10-03.01 Requesting / Delineating Clinical Privileges

      10-03.02 Provider Network Credentialing Application

      10-03.03 Provider Network Credentialing Appointment & Credentialing Committee

      10-03.04 Suspension of Credentialed Status and Appeal

      10-03.05 Provider Training Requirements

      10-03.06 Disclosure of Ownership Control and Criminal Conviction

10-04   Provider Relations

      10-04.01 Provider Orientation

      10-04.02 Provider Grievance & Appeals Process

CARF Requirements for Unaccredited Providers