Understand NCQA, URAC, and CMS requirements for health plans.

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Credentialing for Managed Care: Compliant Processes for Health Plans and Delegated Entities

New to managed care credentialing? Whether you work for a health plan or a hospital medical staff services department, this how-to guide answers all of your health plan credentialing and enrollment questions.

This book will help you:

  • Understand NCQA, URAC, and CMS requirements for health plans
  • Develop a comprehensive and compliant managed care credentialing program
  • Establish delegated credentialing agreements
  • Audit credentials files
  • Recognize how payer credentialing requirements impact other healthcare organizations
  • Streamline provider enrollment through delegation
  • Identify the differences between hospital and managed care credentialing
  • Evaluate whether a credentials verification organization is right for your organization


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