Submit a complete organizational credentialing application that includes the required attachments indicated in the cover letter.
All organizational providers must submit requested documentation. Organizations that do not satisfy all criteria are not eligible for participation. Medica management will return all application materials received from such ineligible organizations.
Medica shall conduct a quality assessment site visit to any site that is unable to provide evidence of acceptable Joint Commission, American Association for Ambulatory Surgery Facilities (AAASF), Community Health Accreditation Program (CHAP) accreditation (for home health care agencies), or American Association of Ambulatory Health Care (AAAHC) accreditation, or an acceptable Centers for Medicare & Medicaid Services (CMS) or state review. Medica may conduct a site visit to any other facility. Such visits shall be conducted in accordance with NCQA standards for site visits. All applicants shall fully cooperate with any site visit request.
Medica shall determine, based upon the provisions of applicable federal and state statutes and regulations, whether and when any adverse recommendations shall be reported to the applicable licensing agency or any other appropriate agency or entity. Medica shall be entitled to make its determination in its sole discretion in accordance with such policies and procedures as the Credentialing Subcommittee shall adopt provided, however, that the determination shall be made in good faith. The Credentialing Subcommittee shall notify the affected organizational provider, in writing, in the event such a report is made.
Return to Credentialing Information.