CareGuide carefully selects providers
and monitors their care to members under CareGuide management. CareGuide
credentialing standards follow JCAHO and NCQA guidelines. CareGuide
conducts primary source verification on all providers. Each provider
is responsible to ensure that CareGuide has up-to-date, accurate credentialing
information on file. A credentials file is maintained on all CareGuide
providers.
Providers must submit, arrange for the direct provision, or assist
in the submission of all supporting documents necessary to complete
the credentialing process. CareGuide facilities, home care providers
and physicians are recredentialed every 3 years; however current license
and insurance information should be submitted annually within 10 business
days of renewal. Changes to provider information and regulatory compliance
status must be submitted immediately to CareGuide.
|
Providers are required to complete and forward
to CareGuide at the time of contracting a series of documents. A CareGuide
contract will not be finalized until all credentialing information
is received.
Physician
Document Requirements
Non
-Physician Document Requirements
|
| To remain a CareGuide network provider in good
standing, it is imperative that the provider complete and return the
CareGuide-supplied recredentialing application within 30 days of receipt.
Failure to provide or update required information may result in stoppage
of referrals and is considered grounds for termination from network
participation. For questions concerning recredentialing, call (888)721-9797,
Ext. 63628. |
| |
| go
to top of page |
|
