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Corrective Action Plan

Provider Type

  • Participating Physician Groups (PPG)
  • Hospitals

When a participating physician group (PPG) or hospital is not in compliance with plan policies, contractual obligations or regulatory requirements, the Delegation Oversight Department may implement a corrective action process to correct the deficiencies.

  • Delegate is notified of deficiency and requested to submit a corrective action plan (CAP) to address the deficiency.
    • The delegation oversight compliance auditor reviews the CAP for appropriateness and completeness and notifies the provider of whether the CAP is approved.
    • If the plan does not approve the CAP, the provider is notified and asked to revise and resubmit the CAP to the plan.
  • If the delegate does not submit a CAP, or complete the actions in their CAP in a timely manner, the deficiency is escalated to the Delegation Oversight Workgroup (DOW) to recommend further actions.
  • If the delegate remains deficient it is escalated to the Delegation Oversight Committee (DOC) to take formal actions up to and including de-delegation.
Last Updated: 07/04/2024