Carelon will conduct site visits to the facility or practitioner’s office(s). The criteria for selection of providers to whom site visits are made includes:
- Volume. If Carelon identifies the provider as a potential high-volume provider, a site visit will be conducted upon:
- Initial credentialing
- Recredentialing (at Carelon’s discretion)
- Adding a new practice location or changing group affiliations since the previous credentialing decision.
- Quality. A site visit may be conducted as part of monitoring an investigation stemming from a member complaint or other quality issue.
The provider will be contacted by Carelon to arrange a mutually convenient time for the site visit. It is important to note that the site visit process is intended as a consultative and educational process. It allows Carelon the opportunity to acknowledge areas of strength and identify opportunities for improvement in our provider network. Providers are sent a copy of the site visit tool prior to the actual site visit so they are aware of the areas in which they will be measured. The site visit tools are also available upon request by calling the toll-free provider line at 877-615-8503.
Following the site visit, the provider will receive a written report that details the site visit findings. Included in the report will be an Action Plan that will provide guidance in areas that the provider needs to strengthen in order to be in compliance with Carelon’s standards.