New SelectNet Communications Protocols Now in Place

When these issues arise, they are documented by the medical operations team and investigated to determine validity. An issue, which is termed a Provider Feedback Log entry in the Pinnacol vernacular, is considered valid if a quality of care or quality of service standard is not met. These standards are outlined in a number of Pinnacol network management documents, including the Provider’s Network Agreement and the SelectNet provider manual.

When an issue is determined to be valid and substantiated, the new standardized communication format will be used. Specifically, the provider will receive written notification from Pinnacol noting: (1) the issue in question and the performance standard that was not met; (2) how the issue was resolved; (3) the number of substantiated issues the provider has accumulated since his/her last credentialing cycle and the total number permitted before a mandatory committee review ensues. Upon receipt of this information, the recipient will have the opportunity to provide a written statement explaining his or her perspective on the issue and its resolution. Such comments, if received, will be included as part of the issue’s resolution record.

According to our standards, providers who receive five or more substantiated issues during their current credentialing cycle are required to be reviewed by the Credentialing & Quality of Service Committee (CQSC). A CQSC review may also take place with less than five substantiated issues if an issue is egregious in nature and warrants immediate action.

If you have any questions about this new process, please contact Pinnacol’s medical operations team at 303.361.4945 and speak to the provider relations specialist assigned to your contract.