| Table of Contents |
|---|
Process Group
Register/empanel provider
Objective
Verify provider credentials and qualified services and establish network assignments
Input
Provider license
Physical proximity
Qualifying critera
Maximum number ofbeneficiaries to which a provider can attend(i.e., level of services available based on staff)
Provider type (doctor hospital health center, pharmacist,etc.)
Hospital,health center, pharmacist
Provider banking information (e-payment)
Output
Time-based validation of provider’s qualifications
List of provider qualified procedures and services
Provider identifier
Provider type
Network referral relationships
Task Set
Physical assessment of provider
Credentialing
Network referrals definition
Provider agreement
Measurable Outcomes
List of qualified/verified providers
Updated list of qualified/verified providers
List of credentialed services assigned to each provider
Updated list of qualified/verified providers