Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Vendor Name:
Review Period:
Date of Review:
Reviewer:
Participating Vendor Staff Member:
Agency For Health Care Administration
Managed Care Organizations
Physician Credentialing and Recredentialing File Review Tool
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Physician Initials
1. An individual credentialing/recredentialing file is maintained for each physician.
2. There is a completed credentialing/ recredentialing application signed and dated by the
physician.
3. There is primary source verification to validate that the physician has a valid Florida medical
license pursuant to s. 641.495, F.S. that has not been revoked or suspended by the Division
of Medical Quality Assurance, Department of Health
4. There is a DEA certificate included in the file, if applicable.
5. There is evidence of primary source verification of the physician’ education and training (also
satisfied by verification of Board Certification) for providers in initial credentialing.
6. There is evidence of primary source verification of the physician’s Board Certification.
7. There is evidence of primary source verification of an NPDB query to validate the physician’s
professional liability claims history.
8. There is evidence of the Medicaid ID Number, Medicaid provider registration number, or proof
of submission of Medicaid registration form; or the provider is Medicaid eligible.
Managed Care Organizations Page 1
Phys Credentialing and Recredentialing File Review Tool F2_07_11
Florida Medicaid
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