Search Results

Ama Policy

Physician Information for Credentialing H-450.990

10/16/2019
Credentialing-Deadlines
Ama Policy

Physician Recredentialing by Managed Care Plans H-285.934

10/15/2019
Credentialing-Deadlines
Ama Policy

Managed Care Insurance Company Credentialing H-285.979

08/31/2022
Credentialing-Deadlines
ARC Advocacy Resources

Credentialing Deadlines Model Bill

Imposes deadlines within which a health insurer must process a complete credentialing application: thirty (30) days for primary care physicians and forty-five (45) days for other specialists. The model bill also states that credentialing due to economic factors must be adjusted to take into account the case mix, age, severity of illness, etc., and that during the credentialing process, health insurers must pay the physician for providing services to subscribers.

Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Credentialing-Payment Issues, Model Legislation
State Law

Arizona Rev. Statutes-Title 20-Chapter 27-Article 1. General Provisions

07/28/2023 Arizona Section 20-3453

Credentialing; loading; timelines; exception

Credentialing-Deadlines
State Law

Arkansas Code-Title 23-Subtitle 3-Chapter 99-Subchapter 4. Arkansas Health Care Consumer Act

07/28/2023 Arkansas Section 23-63-411

Processing applications of providers

Credentialing-Deadlines
State Law

Colorado Rev. Statutes-Title 10-Article 16-Part 7. Consumer Protection Standards Act for the Operation of Managed Care Plans

07/31/2023 Colorado Section 10-16-705.7

Timely Credentialing of Physicians by Carriers – Notice of Receipt Required – Notice of Incomplete Applications Required – Delegated Credentialing Agreements – Discrepancies – Denials of Claims Prohibited – Disclosures – Recredentialing – Enforcement – Rules – Definitions

Credentialing-Deadlines, Credentialing-Payment Issues, Directories
State Law

Illinois Compiled Statutes-410 ILCS 517/-Health Care Professional Credentials Data Collection Act

11/02/2023 Illinois Sections 517/5 and 517/10

Definitions; Development and use of uniform health care and hospital credentials forms

Credentialing-Deadlines
State Law

Indiana Code-Title 27-Article 8-Chapter 11-Accident and Sickness Insurance─Reimbursement Agreements

07/13/2023 Indiana Sections 27-8-11-1, 27-8-11-4.5, 27-8-11-7, 27-8-11-8, 27-8-11-9, 27-8-11-11, 27-8-11-13

Definitions; Permitted Disclosures by Providers; Coverage of Benefit or Service; Payment of Provider, Application; Provider Credentialing; Provider Directories; Preferred Provider Agreement Prohibitions; Insurer Payment to Insured for Service Rendered by Noncontracted Provider; Requirements; Fully Credentialed Provider Reimbursement; Requirements

Anti-gag clause, Anti-retaliation, Credentialing-Deadlines, Credentialing-Payment Issues, Directories, Most Favored Nation
State Law

Indiana Code-Title 27-Article 13-Chapter 43. Credentialing

07/13/2023 Indiana Sections 27-13-43-2 and 27-13-43-4

Provider Credentialing; Provisional Credentialing, Criteria, Reimbursement, Termination; Fully Credentialed Provider Reimbursement; Requirements

Credentialing-Deadlines, Credentialing-Payment Issues