General Responsibilities Of The Managed Care Entity

General Responsibilities Of The Managed Care Entity A. A managed care entity shall: 1. Establish written policies and procedures for credentialing verification of all health care professionals with whom the managed care entity contracts and apply these standards consistently; 2. Verify the credentials of a health care professional when entering into a contract with that health care professional. The medical director of the managed care entity or other designated health care professional shall have responsibility for, and shall participate in, health care professional credentialing verification; 3. Establish a credentialing verification committee consisting of licensed physicians and other health care professionals to review credentialing verification information and supporting documents and make decisions regarding credentialing verification; 4. Make available for review by the applying health care professional upon written request all application and credentialing verification policies and procedures; and 5. Keep confidential all information obtained in the credentialing verification process, except as otherwise provided by law. B. Nothing in this regulation shall be construed to require a managed care entity to select a provider as a participating provider solely because the provider meets the managed care entity’s credentialing verification standards, or to prevent a managed care entity from utilizing separate or additional criteria in selecting the health care professionals with whom it contracts.