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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
Ama Policy

Physician Privileges Application -Timely Review by Managed Care D-180.995

10/15/2019

 

Credentialing-Deadlines
Ama Policy

Managed Care Insurance Company Credentialing H-285.979

10/15/2019
Credentialing-Deadlines
Ama Policy

Physician Recredentialing by Managed Care Plans H-285.934

10/15/2019
Credentialing-Deadlines
Ama Policy

Physician Information for Credentialing H-450.990

10/16/2019
Credentialing-Deadlines
State Law

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

06/15/2020 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

06/16/2020 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

09/17/2021 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