N.J. Admin. Code § 11:24B-4.5

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-4.5 - Credentialing

(a) The contract shall specify the party with which the medical director responsible for the credentialing program is employed or affiliated.

(b) The contract shall specify the responsibilities of the ODS and the carrier with respect to the credentialing program, including the transfer of information, and the manner in which the ODS' credentialing program coordinates with the carrier's continuous quality improvement program and complaint system(s), and what obligation the carrier has to assure compliance by providers and other ODS' to comply with the credentialing ODS' standards.

(c) The contract shall specify the time frames for performance of credentialing and recredentialing.

(d) The contract shall specify the composition of the multidisciplinary team that will review provider credentials.

(e) The contract shall specify the verification system and standards that the ODS shall use.

N.J. Admin. Code § 11:24B-4.5