AvMed Physician

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Credentialing AvMed wants you to become part of a 35-year tradition of quality health care. An important component of AvMed Health Plans’ Quality Improvement process is the Credentialing Program. The Credentialing Program is designed to ensure that participating practitioners possess the practice experience, licenses, certifications, privileges, professional liability coverage, education and other professional qualifications to provide a level of professionally recognized care. When selecting providers, AvMed does not discriminate against sex, race, religion, creed, color, age and/or national origin. Composed of multi-disciplinary representation of participating community physicians, the Credentialing Committee reviews applications and credentials of each practitioner upon credentialing and re-credentialing. In the event that a practitioner is denied recredentialing, the practitioner will be given the right to a hearing. Credentialing Important Contact Information AvMed’s Credentialing Department: Contact your Physician Service Representative Council for Affordable Quality Health care (CAQH): 1-888-599-1771 You will be notified of the Credentialing Committee’s decision within 30 days following the monthly committee meeting. Physicians also have the right, upon request, to be informed of the status of their application. All practitioners may review information submitted in support of their credentialing applications. This information is limited to data that is not peer-review protected and can be obtained by the practitioner from the same primary sources utilized by AvMed. All practitioners have the right to correct erroneous information submitted to AvMed by another party. In the event that any information obtained during the credentialing process varies substantially from the information provided to AvMed by the practitioner, the practitioner will be notified in writing and asked to submit written clarification. All information obtained in the credentialing process is maintained in a confidential manner. There is no appeal mechanism available to a practitioner who is denied initial credentialing into AvMed’s Network. To start your credentialing process, please contact your Physician Service Representative. Additional Information found at www.avmed.org. Refer to Chapter 6 of the Physician Reference Guide for: ■ Credentialing ■ Re-credentialing ■ Ambulatory Site Standards AvMed Physician Orientation Manual • 13
Quality Activity The Quality Improvement program lets you impact the future of AvMed health care. AvMed’s Quality Improvement Program The policies, procedure and activities of the AvMed Health Plans Quality Improvement (QI) Department are integrated into a single Quality Improvement Program. AvMed’s Board of Directors oversees the program to ensure that QI functions are timely, consistent and effective. The following are audits performed by AvMed as part of our QI initiatives. Physician Assessment Audits Medical Record Audits: Primary Care Physicians may receive an annual medical record review audit within their outpatient offices. A corrective action plan will be requested when your score is below AvMed’s minimum compliance level. Quality Activity Important Contact Information Quality Improvement: Contact your Physician Service Representative Risk Management: 1-800-346-0231 Fax: 352-337-8526 Accessibility and Availability: Primary Care Physicians may be assessed annually to ensure their compliance with making appointments for members within the recommended AvMed guidelines. A corrective action plan will be requested when your score is below AvMed’s minimum compliance level. After Hours Accessibility: Primary Care Physicians are assessed annually for member’s ability to reach their PCP after hours. According to the PCP contract, you or a designee must be available to members 24 hours a day, 7 days a week. Member Satisfaction with their PCP: AvMed conducts surveys to determine member satisfaction with their PCP. These surveys are conducted and the results are tabulated for AvMed by an NCQA certified market research firm. When appropriate, results are calculated and forwarded to each PCP for review and action. Additional Information found at www.avmed.org. Refer to Chapter 7 of the Physician Reference Guide for: ■ Quality Activities ■ Advance Directives ■ Disrobing Guidelines ■ Risk Management ■ A sample Membership Satisfaction Survey 14 • AvMed Physician Orientation Manual
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AvMed Physician

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