-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 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