Primary Care Physician (PCP) NDC (780519)

Summary: of information used in making a determination, including but not limited to: medical record information, important dates, and any other information used buy the Consultant.

Administrative Deliverables

Prior to beginning work for the Department, Consultant will supply Vendor with the following credentials:

1. Copy of Medical License;

2. Copy of DEA Certification;

3. Copy of any applicable board certification;

4. Verification of ongoing clinical practice;

5. Verification of continuing medical education including dates, topics and credits earned for each educational session;

6. Attestation that no prohibitions, sanctions, or terminations have been levied on Consultant from Federal, State or other health programs in and outside of Pennsylvania;

7. Verification of malpractice insurance (copy of front page of policy); and

8. Documentation statement of any malpractice actions or settlements during the past year.

On an annual basis, the Consultant will provide to Vendor an updated status of items listed above.

Consultant will be required to meet, as a group, with other consultants and staff from the Department on a quarterly basis, (time to be scheduled by the Department) to review:

1. New and old regulations and criteria;

2. How the criteria/regulations can be adhered to under their specialty;

3. Review of work statements to verify objectives are being met;

4. Review volume of reviewed records;

5. Discussion of work production; and

6. Discussion of quality improvement initiatives.

The Consultant will be required to meet with the Department on an individual basis as needed. In addition, the Consultant will be required to meet yearly with the Department at which time a measurement of the Consultant’s performance and expectations will be reviewed. The yearly meeting will include but is not limited to the following items for discussion:

1. Quality of work product;

2. Time and attendance;

3. Criteria Consultant is basing reviews on;

4. Timeliness of reviews;

5. Consistency of reviews in appeals;

6. Preparedness for hearings;

7. Percentage of denials;

8. Percentage of denials upheld; and

9. Peer review and benchmark findings.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

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