New Claims System Update

7.3 Credentialing Committee

Provider Manual
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7 Quality Management

7.3 Credentialing Committee

The Credentialing Committee (CC) has been delegated authority of the credentialing program by the health plan. It is responsible for the oversight of the credentialing program, decisions regarding the credentialing and recredentialing of the practitioners and providers contracted with IntegraNet, and oversight of organizations for which credentialing has been delegated.

The CC’s responsibilities are to:

  • Consider/act in response to provider sanctions.
  • Approve credentialing/recredentialing policies and procedures.
  • Review practitioner and provider credentialing and recredentialing applicants for participation in IntegraNet provider       networks.
  • Provide pre-delegation, ongoing oversight and annual review of delegated entities.
  • Approve/deny participation at initial credentialing based on credentials meeting or not meeting standards for       participation.
  • Approve/term continuing participation at recredentialing based on credentials meeting/not meeting standards for       participation.