Manwal ng Tagabigay


Carelon has a standing committee comprised of representatives of major clinical disciplines, participating providers and representatives of engagement center and corporate departments including national network management, provider relations, quality management and clinical services. The National Credentialing Committee (NCC) provides oversight, meaningful advice, recommendations on policy and decisions regarding credentialing, recredentialing and provider sanctions using a peer review process.

The NCC regularly reports its activities to Carelon’s Corporate Quality Council (CQC). The NCC reviews and investigates provider issues that may be grounds for denying initial credentialing or recredentialing, sanctions or disenrollment. After careful review of these issues, the NCC will make a decision regarding whether credentialing or recredentialing should be approved, a provider should be sanctioned or disenrollment is required.

Carelon has a licensed representative from Network Management that is a member of the National Credentialing Committee. Any time a quality of care issue pertaining to Carelon is presented to the NCC, the recommendations of the NCC are brought back to the Quality of Care Committee for review.