Notification Requirements - (Rev. 4, 07-18-03)

7210 - Notification Requirements - (Rev. 4, 07-18-03) When you identify a potential quality concern, issue a written notice to the provider and to any physicians apparently involved in the concern. Advise them of your concern, and offer them an opportunity to discuss the potential concern. Send notices only to the physicians involved in a concern who can provide you with information necessary for you to make a quality determination (See Exhibit 7-74). Much of the information in notices sent to the involved physicians may be identical. However, preserve the confidential nature of the communication to each physician. Tailor each notice to elicit each physician's unique perspective on the concern in question. Inform each physician only of his/her involvement in the potential concern. Do not advise a physician of another physician's involvement. Do not needlessly proliferate notices to physicians. Send only those notices necessary for resolution of the potential concern. If, after the opportunity to discuss, you believe that an additional physician(s) should be contacted, issue an additional preliminary notice(s), as appropriate. Once you have completed your review of the potential quality concern (after the opportunity to discuss has been offered), issue a written final notice to each party to whom you sent an initial notice, advising them of your favorable or unfavorable quality determination. If you conduct a re-review of a confirmed quality concern, issue a written notice to the provider and any physicians affected by your re-review determination, advising them of your favorable or unfavorable quality determination. Issue separate, original notices in all cases. Issuing copies to the provider or physician is not acceptable. NOTE: Your agreement with the provider may specify where to send your provider notices. It is expected that the designated contact(s) would represent both the administrative and medical staffs (e.g., Chair of the Quality Assurance Committee).