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Atlantis Health Plan has entered into contractual arrangements with clinical laboratories to provide laboratory services to its members. Contracted lab facilities are the only facilities which Atlantis Health Plan members should utilize for routine outpatient lab work.

Generally, these laboratories offer a wide spectrum of diagnostic testing which includes the standard clinical lab tests, the latest highly specialized tests and multiphasic test profiles. Each contracted lab has agreed to deliver all laboratory reports for routine work within forty-eight hours after pick-up; to immediately notify physicians of critically abnormal test results; to provide telephone consultation to physicians; and to provide routine supplies and equipment.

In emergency situations you may send tests that require immediate results outside of the designated laboratory. In such instances, it is imperative that Atlantis Health Plan be notified within twenty-four hours, or on the next business day, so we can authorize payment. Repeated noncompliance with this notification requirement may involve a financial sanction to the ordering physician.

CREDENTIALING/RECREDENTIALINGGUIDELINES

It is the policy of Atlantis that all participating practitioners shall complete the initial credentialing process before they can treat an Atlantis member.

All participating practitioners shall undergo and complete a recredentialing review every two years. Upon request, Atlantis Health Plan will make the application procedures and qualification requirements available to health care professionals.

Atlantis Health Plan may delegate credentialing and recredentialing activities as appropriate. If any portion of the credentialing or recredentialing process is delegated, Atlantis Health Plan "Delegated Credentialing and Recredentialing Policy" will be followed. Atlantis Health Plan shall retain the right to approve new practitioners, providers and sites, to determine if current participating practitioners should be recredentialed, and to terminate or suspend individual practitioners and providers. Atlantis shall monitor the effectiveness of the delegated credentialing and recredentialing processes at least annually.

The Credentialing Committee, as described in the QI Program Description and as designated by Atlantis Health Plan's QI Committee, is responsible for oversight of the qualifications of participating practitioners. Credentialing Committee recommendations will be reviewed by the Medical Director and by Senior Management as indicated in the QI Program description.

Atlantis will conduct and document a structured site review to evaluate the site/office facilities and medical record-keeping practices of those practitioners identified as having areas of concern (for example, in member complaints), and/or those practitioners who have opened new offices since initial credentialing. The survey will include at least the following:

• Physical accessibility;
• Physical appearance;
• Adequacy of waiting area and examining room space;
• Evaluation of medical record keeping practices;
• Confidentiality and maintenance of medical records;
• Performance against established medical record documentation standards;
• Availability of appointments in accordance with Atlantis standards;
• Performance goals for the above items; and
• Evidence that the results of the office site review was shared with the provider.

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