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 the contracting entity's credential verification program before contracting to ensure that the entity complies 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 quarterly.

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

History Note:        Authority G.S. 58-2-40(1); 58-65-1; 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996;

Readopted Eff. December 1, 2017.