2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Credentialing and RecredentialingCurrent malpractice insurance coverage in therequired amount (as described in greaterdetail later in this chapter)Acceptable office practices and a safe officeenvironment that requires a minimum score of90 percent on the initial site visitWork history that reflects a consistent patternof professional activity in good standing for thepast five yearsAbsence of evidence that the applicant mightbe unable to perform the contracted dutiesAbsence of suspension, restriction, ortermination of hospital privilegesNational Provider IdentifierOrganizational ProvidersOrganizational providers must meet the followingstandardized criteria, which includes but is notlimited toCurrent good standing with state and federalregulatory bodies and certified by theappropriate state certification agency, asapplicableHas been reviewed and accredited by arecognized accrediting body or, if notapproved by an accrediting body, meetsPresbyterian’s standards of participationCurrent applicable state license or certificationNo sanctions, suspensions, or terminationsimposed by Medicare, Medicaid, otherdesignated federal/regulatory bodies, or thestate where services are renderedWhen contracted to see Medicare or Medicaidpatients, has not opted out of the Medicare orMedicaid programProviders who serve Medicare members mustbe Medicare-approvedCurrent malpractice insurance coverage in therequired amount (as described in greaterdetail later in this chapter)Acceptable malpractice history within the twoyearperiod immediately preceding the date ofapplicationValid DEA certificate and applicable statepharmacy registration for controlledsubstancesMalpractice Insurance RequirementsProviders are required to maintain, at their sole costand expense and at all times, both comprehensivegeneral liability insurance and professional liabilityinsurance. This insurance must contain provisionsand be written by companies reasonablyacceptable to Presbyterian. Providers mustdemonstrate compliance with this requirement byproviding Presbyterian with certificates evidencingdates that this insurance is in effect, as well asamounts. Notwithstanding these guidelines,Presbyterian reserves the right, on a case-by-casebasis, to require either higher or lower limits, orother terms and conditions depending uponcircumstances or other facts that Presbyterian, inits sole discretion, deems necessary to meet itslegal and regulatory obligations. Currently,Presbyterian requires the following amounts ofcoverage:16-42014 Practitioner and Provider Manual - Ver. 3