The following paragraph contains an incomplete statement. Select the answer choice containing the term that correctly completes the statement. One important activity within the scope of network management is ensuring the quality of the health plan's provider networks. A primary purpose of __________________ is to review the clinical competence of a provider in order to determine whether the provider meets the health plan's preestablished criteria for participation in the network.
A) authorization
B) provider relations
C) credentialing
D) utilization management

Question

Quizplus · Accepted Answer

Credentialing involves evaluating and verifying the qualifications and clinical competence of healthcare providers to ensure they meet the pre-established criteria for participation in a health plan's provider network. Authorization involves determining whether a specific medical service or procedure is covered under a patient's health plan. Provider relations involve building and maintaining relationships with healthcare providers within the provider network. Utilization management focuses on managing the appropriate use of medical resources and services to improve quality of care and reduce costs.

The Following Paragraph Contains an Incomplete Statement