Verification Responsibilities of the Managed Care Entity

Verification Responsibilities of the Managed Care Entity A managed care entity shall: A. Obtain primary verification of at least the following information about the applicant: 1. Current license or certification to practice in this and all other states and history of licensure or certification; 2. Status of primary admitting hospital privileges, if applicable; 3. Specialty board certification status, or, if not board certified, the highest level of education obtained; 4. Malpractice history within the last five (5) years. B. Obtain by either primary or secondary verification at the managed care entity’s discretion: 1. Current level of professional liability coverage; 2. Practice history for at least five (5) years; 3. Status of hospital privileges other than the primary admitting hospital, if applicable; 4. Completion of medical, health care professional and/or post graduate training, other than the highest level of education obtained; 5. Current Drug Enforcement Agency (DEA) registration certificate, if applicable. C. Every three (3) years obtain primary verification of a participating health care professional’s: 1. Current license or certification to practice in this and all other states; 2. Status of primary admitting hospital privileges, if applicable; 3. Specialty board certification status, if applicable; 4. An update regarding the health care professional’s malpractice history. D. Every three (3) years obtain, by either primary or secondary verification, at the managed care entity’s discretion: 1. Status of the health care professional’s hospital privileges other than the primary admitting hospital, if applicable; 2. Current level of professional liability coverage; 3. Current DEA registration certificate, if applicable; E. Require all participating providers to notify the managed care entity of changes in the status of any of the items listed in this Section at any time and identify for participating providers the individual to whom they should report changes in the status of an item listed in this Section.