Provider Manual Home Page
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