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Organizational Credentialing

Organizational Providers include an institution or organization that provides services, such as a hospital, residential treatment center, home health agency or rehabilitation facility.

Organizational Provider Applicants must submit a standardized application for review when applying for initial participation in CCHP's Network. If the Applicant meets pertinent CCHP screening criteria, the credentialing process will commence. In addition to the licensure and other eligibility criteria for Organizational Providers, as described in detail below, all Organizational Providers are required to maintain accreditation by an appropriate, recognized accrediting body or, in the absence of such accreditation, CCHP may evaluate the most recent site survey by Medicare or applicable Wisconsin oversight agency performed within the past 36 months for a given Organizational Provider. During the credentialing process, CCHP will review the verification elements shown in “Criteria for Selecting Providers” unless otherwise required by applicable regulatory or accrediting bodies. 

Organizational Provider Eligibility Criteria:

All Organizational Providers must be accredited by an appropriate, recognized accrediting body or in the absence of such accreditation, CCHP may evaluate the most recent site survey by Medicare or the appropriate state oversight agency performed within the past 36 months. Non-accredited Organizational Providers are subject to individual review by the Credentialing Committee and will be considered for Covered Individual access need only when the Credentialing Committee review indicates compliance with CCHP standards and there are no federal or state-level deficiencies or sanctions that would adversely affect quality of care or patient safety.

  • General Criteria for Organizational Providers:
  1. Valid, current and unrestricted license to operate in Wisconsin. The license must be in good standing with no sanctions.
  2. Valid and current Medicare and Medicaid certification. 14
  3. Must not be currently debarred or excluded from participation in any of the following programs: Medicare, Medicaid or FEHBP.
  4. General/comprehensive liability insurance as well as errors and omissions (malpractice) insurance of not less than $1,000,000 per occurrence and $3,000,000 in the general aggregate with an insurer licensed to provide medical malpractice insurance in Wisconsin, or show similar financial commitments made through an appropriate Wisconsin approved alternative, as determined by CCHP and appropriate secondary coverage by the Wisconsin Injured Patients and Families Compensation Fund. The pertinent Network Agreement may require coverage that exceeds the minimum level described above.
  5. Accredited Organizational Providers must provide proof of current accreditation status conducted during the previous three (3) year period and active federal or state licensure as applicable. CCHP will accept accreditation results from:
  • AAAHC - Accreditation Association for Ambulatory Health Care.
  • ABCOP - American Board for Certification on Orthotics and Prosthetics.
  • ACR - American College of Radiology.
  • AOA - American Osteopathic Association.
  • CAP - College of American Pathologists.
  • CARF - Commission on Accreditation of Rehabilitation Facilities.
  • CHAPS - Community Health Accreditation Program.
  • CCAC - Continuing Care Accreditation Commission.
  • CLIA - Clinical Laboratory Improvement Amendment certification. Please note: Certification required not just CLIA license.
  • COLA - Commission on Office Laboratory Accreditation.
  • TJC - The Joint Commission.
  • NCQA - National Committee for Quality Assurance.
  • If not appropriately accredited, Organizational Provider must submit a copy of its CMS or state site survey for review by the Credentialing Committee to determine if CCHP’s quality and certification criteria standards have been met.

Please fill out this organizational credential application

Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

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