Question: Credentialing is a process that both managed care organizations and providers must undergo in order to be involved in managed care programs . What is

Credentialing is a process that both managed care organizations and providers must undergo in order to be involved in managed care programs.

  • What is credentialing in managed care contracting and why is it an important function?
  • Describe a typical credentialing process including the different steps that are required and explain why they are necessary.
  • Discuss some possible problems that may arise for any steps that are not completed.
  • For a member of the provider network such as a physician, provide examples of 2-3 specific regulatory credentialing requirements imposed by your state for this type of health professional. Visit your states department of insurance for this information.

Step by Step Solution

There are 3 Steps involved in it

1 Expert Approved Answer
Step: 1 Unlock blur-text-image
Question Has Been Solved by an Expert!

Get step-by-step solutions from verified subject matter experts

Step: 2 Unlock
Step: 3 Unlock

Students Have Also Explored These Related General Management Questions!

Q:

Help please! I am trying to organize a paper to analyze an SEC 10K for the Pfizer company for a final project but I do not know where to start. Attached is the SEC 10K report, and I have to use three...

Q:

Help please! I am trying to organize a paper to analyze an SEC 10K for the Pfizer company for a final project but I do not know where to start. Attached is the SEC 10K report, and I have to use three...

Q:

1. Read Financial Statement Analysis Case then use the Walgreens Financial Statements to answer the questions. 2. Read P4-1 then follow the instruction. (Make sure all answers are correct and do not...

Q:

from pages 5-39 of Stanford's Health Care Report- any particular point that feel may be relevant or interesting in regards to financial status current or future for Stanford. Has to be least 200...

Q:

Using the Stanford Health Care Consolidated Financial Statements for 2014 ( pages 1-4 ), prepare a brief summary (3 -4 paragraphs) that highlights the current financial status of Stanford and any...

Q:

Window Help ew Assessment Homework Help - Q&A from Or X + elearn.monroecollege.edu/ultra/grades/assessment/_3285811_1/overview/attempt/_9579107_1?courseld=_47388_1 111 minutes remaining 50 OF 50...

Q:

Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency...

Q:

Because Medicaid Expansion requires greater state expenditure, most states opted out of the program. Group of answer choices True False Flag question: Question 2 Question 2 1 . 5 pts What is the main...

Q:

Calculate these numbers for 2010 Annual Report Net Income Preferred Dividends Average Common shares outstanding Stock price per share Earnings per share Gross profit Net Sales Average total assets...

Q:

Prepare a three year strategic plan of Merck & Company Inc. based on the following case study. (Kindly no copy pasting/plagiarism) History Merck was established in 1891 to engage in the discovery,...

Q:

Your grandmother was so proud of her first grandchild that she started a savings plan for you when you were born. The saving plan has an interest rate of 7 percent compounded monthly and the terms of...

Q:

In a chlorine-fluxing installation in a large aluminum company, engineers are considering the replacement of existing plastic pipe fittings with more expensive, but longer lived, copper fittings. The...

Q:

In relation to the Sarbanes - Oxley Act, which individual must certify the effectiveness of internal controls? Question 3 5 Answer a . Internal auditor b . Controller c . Independent consultant d ....

Q:

Case Greenbuilders Pte Lid ("GPL") is a local construction company which specialises in providing bespoke Design and Build construction services for private residential homes that are designed to be...