Ancillary Provider Initial Credentialing & Re-Cred Checklist

COPY of Application (place in the front of the chart) NA. Phone Logs (PLOGS) (Re-cred only) Performance Monitoring QI/MI form – Capture dates since previous Cred cycle. End date range no older than 120 days. Directory Verification (Re-cred only) NA. Ancillary Grid Audit. PHC # (re-Cred) Facility & Corporate Address Match App. License # & Exp ... ................
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