-Network Management

Provider Manual Home Page

NETWORK MANAGEMENT

Includes: Provider Network Membership; Provider Network Contract Management; Provider Network Credentialing; Provider Relations; Accreditation Requirements. 

Provider Network Policies & Procedures:
10-01 Provider Network Management (1.2021)
      10-01.01 Provider Manual (12/2020)
      10-01.02 Auditing, Certification and Accreditation (12/2020)
      10-01.03 Network Development & Capacity Evaluation (12/2020)
     
10-01.04 Delegating Managed Care Functions (12/2020)
      10-01.05 Person-Centered Planning (4/2021)
     
 10-01.06 Self Determination and Self-Directed Services (11/2020 - service providers only)
      10-01.07 Infant Mental Health Services (12/2020)
      10-01.08 Environment of Care Standards for Residential Providers (12/2020)
      10-01.09 Respite Services (12/2020)
      10-01.10 Recovery Based Services (11/2020)
      10-01.11 Community Based Services (1/2021)
      10-01.12 Primary Case Holder Services (2/2021)
      10-01.13 Housing Assistance (1/2021)
      10-01.15 Multi-Systemic Therapy (MST) (LifeWays Contracted Providers only 11/2020)

10-02 Provider Network Contract Management
      10-02.01 Auditing Certification and Accreditation
      10-02.02 County of Financial Responsibility (COFR) (revised 11/24/20)
      10-02.03 Out of Network Contracting
      10-02.04 Contract Development and Distribution (revised 11/24/20)
      10-02.05 Disclosure of Ownership, Control, and Criminal Convictions
 
10-03 Credentialing (effective 12/18/20)
      10-03.01 Credentialing and Privileging
      10-03.02 Credentialing Application (replaces Provider Network Credentialing Application 11/24/20)
      10-03.03 Credentialing Committee
      10-03.04 Suspending, Limiting, and Terminating Credentialing
      10-03.05 Provider Training Requirements (revised 11/24/20)
      
10-04   Provider Relations (revised 12/18/20)
      10-04.01 Provider Orientation (revised 11/24/20)
      10-04.02 Provider Resolution Process
      10-04.05 Provider Claims Processing and Verification (revised 2/2021)

CARF Requirements for Unaccredited Providers