Ohio Admin. Code 5160-1-42.1 - Delegated credentialing
(A)
The Ohio
department of medicaid (ODM) authorizes eligible provider delegates to perform
credentialing activities on behalf of individual providers in accordance with
rule 5160-1-42 of the Administrative
Code.
(B)
"Delegate" and "Delegation" have the same meaning as in
rule 5160-1-42 of the Administrative
Code.
(C)
Entities seeking delegation will be expected to meet
the following criteria to become an authorized delegate and to maintain
delegate status:
(1)
Be an eligible provider as defined in rule
5160-1-17 of the Administrative
Code:
(2)
Participate with home-state agency that administers
titles XIX (medicaid), XXI (children's health insurance program - CHIP), or
XVIII (medicare) of the Social Security Act;
(3)
Be based in Ohio
or a contiguous state;
(4)
Have at least fifty Ohio medicaid enrolled and active
affiliated individual providers;
(5)
Submit to the
credentialing department a request in writing; and
(6)
Complete a
pre-delegation audit conducted by ODM to include review of the following
information maintained by the delegate:
(a)
Credentialing
policies and procedures;
(b)
Sample of practitioner credentialing
files;
(c)
Credentialing meeting minutes; and
(d)
Ongoing sanctions
monitoring.
(D)
ODM has the right
to deny or terminate delegation status. Denial or termination of delegation
status does not afford hearing rights.
(E)
Delegated
credentialing of facilities is not permissible under the ODM delegated
credentialing agreement.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5164.32
Rule Amplifies: 5162.03, 5164.02, 5164.32
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