Delegated agreements with health care plans require significant oversight and verification. Consider the many services Managed Care Partners offers that can relieve some or all of your administrative burden:

Delegated initial and re-credentialing of practitioners:

• Review of application and attestation to ensure it is complete and accurate
• Primary source verification (customizable by state), including:
  -Licensure
  -Board certification
  -DEA certification
  -NPI
  -Education and training
  -Hospital privileges
  -Professional liability insurance
  -Professional liability claims review
  -Federal and state sanctions and exclusions

Delegated initial and re-credentialing of facilities:

Primary source verification:

• • • Facility licensure
    • DEA certification
    • CLIA/CLIA waiver
    • Pharmacy license
    • NPI
    • General liability insurance
    • General and professional liability claims review
    • Federal and state sanctions and exclusions

Monthly preparation of information for your credentialing committee review:

• Individual practitioner or facility checklists
• Individual practitioner profile sheets
• Committee minutes/review signature sheets

Monthly practitioner and facility roster submission/payer enrollment to delegated payers:

• Addition of new practitioner/facilities
• Changes/updates of existing practitioner/facilities
• Termination of practitioner/facilities
• Submission of information customized to each health plan’s requirements

Monthly continuous monitoring for practitioners including:

• Federal and state sanctions/exclusions via:
  -Federal OIG
  -State OIG (if applicable)
  -System for Award Management
  -License to practice
• Professional liability claims
  -Complaints reported to network and/or payers

Maintenance of practitioner expirables including:

-DEA certification
-Licensure
-Board Certification

• Quarterly delegated reporting to health plans as required
• Annual payer policy audits as required by health plans
• Annual and semi-annual credentialing audits by health plans
• Maintaining and updating credentialing policies and procedures as required by health plans and accreditation oversight entities
• Act as the liaison between the health plan and your network to resolve contracting questions or claims issues arising from credentialing/enrollment
• Work directly with health plans to increase products (Medicaid, Medicare, PPO, HMO) included in delegated credentialing