Horizon-accredited hospital physicians are not required to perform a CCCA because they sign documents with Horizon indicating which physicians they have covered agreements with. In such cases, the referring physician also executes a form indicating their participation in the hospital program, but which generally maintains its hospital privileges. An agreement with a provider not to charge the subscriber a difference between the fees charged for covered services (excluding co-insurance) and the amount agreed by contract with a Blue Cross Blue Shield company as a full payment for these services. The Commission reserves the right to review disciplinary measures, arrests, convictions, convictions and participation in intervention measures that have nothing to do with patient care. The Credentials Committee (the Committee), a committee of Horizon`s Quality Improvement Committee, is Horizon`s committee responsible for verifying the network`s first testimonies and redeployments to physicians and health professionals. The committee is chaired by the Executive Director, Quality Management or his advisor, who oversees the registration program. The committee, its composition and modus operandi are described in detail in a separate policy entitled “Credentials Committee.” The Committee has the definitive authority to approve or disapprove of candidates for the first certification and new certifications. The committee evaluates all candidates for participation against Schedule A participation standards. Exception: Advanced Practice Nurse (APN) specializing in behavioral health ensures a collaborative practice agreement only for the prescription of nurses.
The Medicare component, which provides basic hospital insurance to cover hospitalization costs, retention in care facilities or other advanced care facilities after hospitalization, post-hospital home care after hospitalization and palliative care. Hospital privileges must be full and full with “full license,” “active,” “provisional,” “participant,” “Associate,” or “Affiliate” status. Authorization status should not be: Temporary, Courtesy, Consulting, Consulting Admitting, Applied, Limited or Pending. . The physician`s executive health plan, which is responsible for the quality and cost-effectiveness of medical care by plan providers. Also known as the Medical Director. A person or organization that cares for patients from outside the local plan. Services can be provided from a single site or multiple sites.
The service provider is the one who has a right to a service provided to the member. BlueCard applies if the service provider is outside the member`s Blue Cross Blue Shield plan and does not agree with the member`s plan. The member`s location at the time of service is irrelevant. Often, the patient and the indirect care provider are in different physical locations. WalkingWorks© is a fitness and wellness program developed by Blue Cross Blue Shield, developed in collaboration with the President`s Council of Physical Fitness and Sports, to help BCBS members achieve fitness goals while improving your overall health. The website allows members to record daily activities and track progress over time. An independent centre that performs different types of operations. Certified Social Worker (LCSW, MA): Clinical social workers must have a master`s or doctoral degree in social work from a school accredited by the Social Work Council and have experience of at least 3000 hours of direct contact with clients two years after the master`s degree. Administrative Policy: The registration and recredentialing policy for participating physicians and health professionals Note: If any of the above criminal history is available, the Credentials Committee reserves the right to determine whether such issues indicate a current or persistent quality of care or any other issue that excludes authorization from certification.