Provider Oversight
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
This section contains general information on provider oversight requirements and monitoring.
Select any subject below:
- Overview
- Calendar of Required PPG Submissions
- Corrective Action Plan
- Fraud, Waste and Abuse
- Member Appeals and Grievances
- Monitoring Provider Exclusions
- Special Needs Plan Model of Care
- Subdelegated Functions
- Contractual Financial and Administrative Requirements
- Delegated Medical Management
- Facility and Physician Additions, Changes and Deletions
- Service and Quality Requirements