PWS ATTACHMENT B - MONTHLY REPORT TEMPLATE.xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- R699-- Address Vendor Questions - Credentials Verification Organization for Non-CCN providers
- Solicitation number
- 36C10X21Q0168
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C10X21Q0168 0001_1.docx | DOCX document | |
| 36C10X21Q0168 0001 (Final).pdf | ||
| PWS ATTACHMENT A - QUALITY ASSURANCE SURVEILLANCE PLAN - 07.16.2021.docx | DOCX document | |
| ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| ATTACHMENT C - PRICE SCHEDULE.xlsx | XLSX spreadsheet | |
| 36C10X21Q0168 (Final).pdf | ||
| PWS ATTACHMENT C- CREDENTIALING APPLICATION REQUEST EXAMPLE.docx | DOCX document | |
| ATTACHMENT A - PAST PERFORMANCE REFERENCES.pdf | ||
| 36C10X21Q0168_1.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Access Database Date of Outage Length of Outage Actions taken to mitigate outage
Initial Credentialing
| NPI | Provider Name or Entity Name | Provider or Entity Classification | Start Work File Title | Start Work File Rec'vd | First date of contact to provider |
| 111111111 | SB Home Health | Entity | SWF 001 | 3/13/20 | 3/14/20 |
Credential Verification
| Total Providers Credentialed in Previous Month | 1 | ||||
| Provider NPI | Provider Name or Entity Name | Initial or re-credentialing | PSV completed | Board Review Date | Graded Risk Assessment |
| 111111111 | SB Home Health | Initial or re-credentialing | 5/28/20 | 6/3/20 | Reject |
Returned Providers
| Provider NPI | Provider Name or Entity Name | VA Requested Return (Yes/No) | ||||||||
| Yes Answer does not require completion of remaining fields | Contact Attempt 1 Date | Contact Attempt 1 Modality | Contact Attempt 2 Date | Contact Attempt 2 Modality | Contact Attempt 3 Date | Contact Attempt 3 Modality | Contact Attempt 4 Date | Contact Attempt 4 Modality | Contact Attempt 5 Date | Contact Attempt 5 Modality |
Monitoring
| NPI | Provider Name | Date notified of Flag | Reason for Provider flagged |
| 11111111 | John Smith | 7/14/20 | License Suspended due to clinical quality |
Credential Board Status
| Provider brief description of current status of Credentialing review board (Max 500 Characters) |
| E.G.1. Board stood up and final education completed 6/3/2020. |
E.G.2. Board Chair out for PTO for 2 weeks in previous month, credentials not reviewed weeks of 7/6 and 7/13
File details come from the government source that posted it. Updated .