11 NCAC 20 .0410. DELEGATION OF CREDENTIAL VERIFICATION ACTIVITIES

Whenever any carrier delegates credential verification activities to a contracting entity, whether an intermediary or subcontractor, the carrier shall review and approve the contracting entity's credential verification program before contracting and shall require that the entity comply with all applicable requirements in this Section.  The carrier shall monitor the contracting entity's credential verification activities.  The carrier shall implement oversight mechanisms, including:

(1)           Reviewing the contracting entity's credential verification plans, policies, procedures, forms, and adherence to verification procedures.

(2)           Requiring the contract entity to submit an updated list of providers no less frequently than quarterly.

(3)           Conducting an evaluation of the contracting entity's credential verification program at least every three years.

 

History Note:        Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-67-5; 58-67-10; 58-67-20; 58-67-35;

58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996.