Care Improvement Plus! This provider manual

Care Improvement Plus maintains a comprehensive credentialing program; developed in accordance
with CMS and the National Committee for Quality Assurance (NCQA) standards. The credentialing
process involves several steps including application, primary source verification, Credentialing
Committee review and provider notification.
All providers applying to the Care Improvement Plus network have the right to:
• Review information obtained in support of their credentialing application except for
references, recommendations or other information peer review protected by law.
• Respond to information obtained during the credentialing process that is discrepant with
the information submitted on their credentialing application.
• Correct erroneous information that may have been submitted.
• Be informed of the status of their credentialing or re-credentialing application upon
request.
The credentialing program is periodically reviewed by the Credentialing Committee and revised
when necessary. All information obtained during the credentialing process is held in the strictest
confidence. All providers shall be notified in writing of any denial, suspension or termination.
Re-Credentialing
Providers are re-credentialed every three (3) years of the date of their last credentialing cycle. The basic
process is the same as the initial credentialing process. Additional criteria that may be used during the recredentialing
process include, but are not limited to:
• Compliance with health plan policies and procedures.
• Sanctions related to utilization management, administrative or quality of care issues.
• Member complaints
• Member satisfaction survey results
• Participation in quality improvement activities
SECTION G – USE OF ANCILLARY PROVIDERS
Ancillary Services
Laboratory Services
Any Medicare certified laboratory provider may be used. Physicians may do limited lab work in their
offices – some services will be considered “bundled charges” and will not be paid in addition to an office
visit. For a listing of contracted laboratory facilities in your area, search our online provider directory or
contact our Provider Relations department.
Radiology Services
Any Medicare certified radiology provider may be used. For a listing of contracted radiology
facilities in your area, search our online provider directory or contact our Provider Relations
department.
Physical Therapy
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