(a) In addition to the information filed under G.S. 131E‑280,each application shall include a description of the following:
(1) The program to be used to evaluate whether the applicant'snetwork of sponsoring providers and contracted providers is sufficient, innumbers and types of providers, to assure that all health care services will beaccessible without unreasonable delay;
(2) The program used to evaluate whether the sponsoringproviders provide a substantial portion of services under each Medicarecontract of the PSO;
(3) The program to be used for verifying provider credentials;
(4) The utilization review program for the review and control ofhealth care services provided or paid for by the applicant;
(5) The quality management program to assure quality of care andhealth care services managed and provided through the health care plan; and
(6) The applicant's network of sponsoring providers andcontracted providers and evidence of the ability of that network to provide allhealth care services other than out‑of‑network services andemergency services to the applicant's prospective beneficiaries.
(b) The Division may promulgate rules and regulations exemptingfrom the filing requirements of subsection (a) of this section those items itdeems unnecessary. (1998‑227, s.1.)
(a) In addition to the information filed under G.S. 131E‑280,each application shall include a description of the following:
(1) The program to be used to evaluate whether the applicant'snetwork of sponsoring providers and contracted providers is sufficient, innumbers and types of providers, to assure that all health care services will beaccessible without unreasonable delay;
(2) The program used to evaluate whether the sponsoringproviders provide a substantial portion of services under each Medicarecontract of the PSO;
(3) The program to be used for verifying provider credentials;
(4) The utilization review program for the review and control ofhealth care services provided or paid for by the applicant;
(5) The quality management program to assure quality of care andhealth care services managed and provided through the health care plan; and
(6) The applicant's network of sponsoring providers andcontracted providers and evidence of the ability of that network to provide allhealth care services other than out‑of‑network services andemergency services to the applicant's prospective beneficiaries.
(b) The Division may promulgate rules and regulations exemptingfrom the filing requirements of subsection (a) of this section those items itdeems unnecessary. (1998‑227, s.1.)
(a) In addition to the information filed under G.S. 131E‑280,each application shall include a description of the following:
(1) The program to be used to evaluate whether the applicant'snetwork of sponsoring providers and contracted providers is sufficient, innumbers and types of providers, to assure that all health care services will beaccessible without unreasonable delay;
(2) The program used to evaluate whether the sponsoringproviders provide a substantial portion of services under each Medicarecontract of the PSO;
(3) The program to be used for verifying provider credentials;
(4) The utilization review program for the review and control ofhealth care services provided or paid for by the applicant;
(5) The quality management program to assure quality of care andhealth care services managed and provided through the health care plan; and
(6) The applicant's network of sponsoring providers andcontracted providers and evidence of the ability of that network to provide allhealth care services other than out‑of‑network services andemergency services to the applicant's prospective beneficiaries.
(b) The Division may promulgate rules and regulations exemptingfrom the filing requirements of subsection (a) of this section those items itdeems unnecessary. (1998‑227, s.1.)
