N.J. Admin. Code § 11:24B-4.5 - Credentialing
(a) The
contract shall specify the party with which the medical director responsible
for the credentialing program is employed or affiliated.
(b) The contract shall specify the
responsibilities of the ODS and the carrier with respect to the credentialing
program, including the transfer of information, and the manner in which the
ODS' credentialing program coordinates with the carrier's continuous quality
improvement program and complaint system(s), and what obligation the carrier
has to assure compliance by providers and other ODS' to comply with the
credentialing ODS' standards.
(c)
The contract shall specify the time frames for performance of credentialing and
recredentialing.
(d) The contract
shall specify the composition of the multidisciplinary team that will review
provider credentials.
(e) The
contract shall specify the verification system and standards that the ODS shall
use.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.