-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 (to replace Provider Network Membership 12/18/20)
      10-01.01 Provider Manual
      10-01.02 Procurement of Provided Services
      10-01.03 Network Development & Capacity Evaluation
      10-01.05 Person-Centered Planning (revised 11/23/20)
     
 10-01.06 Self Determination and Self-Directed Services (new 11/23/20 - service providers only)
      10-01.10 Recovery Based Services (new 11/24/20)
      10-01.15 Multi-Systemic Therapy (MST) (This procedure applies to LifeWays Contracted Providers) 11/24/20
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 Delegated Managed Care Functions
      10-02.04 Contract Development and Distribution (revised 11/24/20)
      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 Credentialing (effective 12/18/20)
      10-03.01 Requesting / Delineating Clinical Privileges
      10-03.02 Credentialing Application (replaces Provider Network Credentialing Application 11/24/20)
      10-03.03 Provider Network Credentialing Appointment & Credentialing Committee
      10-03.04 Suspension of Credentialed Status and Appeal
      10-03.05 Provider Training Requirements (revised 11/24/20)
      10-03.06 Disclosure of Ownership Control and Criminal Conviction
10-04   Provider Relations (revised 12/18/20)
      10-04.01 Provider Orientation (revised 11/24/20)
      10-04.02 Provider Grievance & Appeals Process

CARF Requirements for Unaccredited Providers