Molina Healthcare of Michigan may delegate Credentialing, UM, and Claim activities to provider groups that meet delegation requirements. Prior to delegation, Molina Healthcare conducts on-site delegation pre-assessments to determine compliance with regulatory and accrediting requirements. The health plan monitors ongoing compliance with review of monthly reports and annual on-site assessments.
The QIC monitors ongoing delegate compliance with regulatory and accrediting requirements. The committee requires corrective action of delegates when necessary. MHM's Director, QI is responsible for the delegation oversight process, which includes coordinating and conducting annual on-site assessments, monitoring credentialing reports, overseeing the corrective action process, and providing staff support.
- Quality Improvement for Behavioral Health
- Utilization Management for Behavioral Health