Managed Care Provider Directory - Blue Cross and Blue Shield of ...
Managed Care Provider Directory - Blue Cross and Blue Shield of ...
Managed Care Provider Directory - Blue Cross and Blue Shield of ...
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MalpracticeCoverageSource Of Information· <strong>Provider</strong> Credentialing Application;· Copy <strong>of</strong> Malpractice Certificate <strong>of</strong> Insurance; <strong>and</strong>· Malpractice CarrierSt<strong>and</strong>ardThe provider has current malpractice liability insurance coverage. $1,000,000 peroccurrence <strong>and</strong> $3,000,000 in aggregate is encouraged.Medicare <strong>and</strong>MedicaidSanctionsSource Of Information· <strong>Provider</strong> Credentialing Application;· National Practitioner Data Bank;· State Board <strong>of</strong> Medical Examiners;· BCBSMT Internal Audit Department; <strong>and</strong>· Newspaper ArticlesSt<strong>and</strong>ardThe provider is currently eligible to participate in Medicare <strong>and</strong>/or Medicaid programs.OtherSource Of Information<strong>Provider</strong> Credentialing Application.St<strong>and</strong>ardPhysician Assistans have a supervising physician.IndividualCriteria <strong>and</strong>OtherConsiderationsIndividual review criteria may include:1. State board disciplinary action/license restrictions;2. Hospital admitting privileges <strong>and</strong>/or disciplinary action;3. Drug Enforcement Agency certification;4. Convictions;5. Alcohol or drug abuse/practitioner impairment;6. Malpractice allegations <strong>and</strong> claims history;7. Claims fraud or abuse;8. Completeness <strong>of</strong> application;9. Completion <strong>of</strong> continuing medical education;10. Additional re-credentialing criteria (PCP <strong>and</strong> OB-GYN <strong>of</strong>fices):- Utilization <strong>and</strong> preventive services data.- Health Employer Data Information Sets (HEDIS) results.
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