|
Health Care Provider Certificate
HEALTH CARE PROVIDER CERTIFICATE PROCESS:
Initial Application: Applications for a health care provider certificate are submitted along with a $1,000 non-refundable application fee. After the application is reviewed and deemed complete, the applicant is notified to contact the agency in writing for an on-site initial survey.
Initial Survey: The on-site review for a health care provider certificate is conducted to assure compliance with Florida Statute and rule. The initial review covers the following areas:
- Governing Body
- Medical Records System
- Quality of Care
- Quality Assurance Program
- Referral procedures
- Internal Risk Management
- Credentialing
- Grievance Procedure
- Provider Network
- Advance Directives
- Member Handbooks and/or Subscriber Agreements
If found to be in compliance, the Agency issues a certificate indicating the counties or parts of counties for which the applicant has been approved.
Renewal: The health care provider certificate is renewed biennually upon submission of an application for renewal and a $1,000 non-refundable application fee. Upon receipt of an application for renewal, the provider network is reviewed for compliance with Florida Statute and rule.
Monitoring: Ongoing monitoring is accomplished through quarterly and annual grievance reports, annual risk management surveys, complaint information from the HMO Complaint Hotline, and investigations of subscriber quality of care complaints. In addition, HMOs are required to maintain accreditation from a nationally recognized accreditation organization approved by the Agency.
Expansions: An HMO or prepaid health clinic may expand their geographic service area by submitting an expansion affidavit. When the affidavit is reviewed and deemed complete, an on-site review is scheduled with the plan to review the provider network it will use in the expanded area. The affidavit also affirms consistent compliance throughout the expanded network with Florida Statute and rule.
Accreditation: Accreditation is a process to measure how a health care organization performs using a nationally recognized set of quality standards. By looking at internal processses of monitoring and evaluating the health care given to members of health maintenance organizations, members are assured of quality services rendered in the most cost effective manner. Since 1992, Florida has required HMOs to be accredited by a nationally recognized accreditation organization whose standards have been approved by the Agency.
The following organizations are approved in the state of Florida:
|
