Search Results

Ama Policy

Fair Market Practices H-285.981

03/13/2019
Credentialing-Due Process-Denial of Contract, Profiling, U.R. Criteria
Ama Policy

Qualifications and Credentialing of Physicians Involved in Managed Care H-285.991

03/13/2019
Credentialing-Due Process-Denial of Contract, Termination, Termination-Due Process
Ama Policy

Managed Care Consensus Bill H-285.941

03/13/2019
Credentialing-Due Process-Denial of Contract, Termination-Due Process
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

Rescinding Provisions Requiring Physicians to Have Hospital Admitting Privileges D-180.994

10/15/2019
Credentialing-Due Process-Denial of Contract
Ama Policy

Discrimination Against Physicians by Health Care Plans H-285.985

10/15/2019
Credentialing-Due Process-Denial of Contract
Ama Policy

Managed Care Organizations – Credentialing H-285.953

10/15/2019
Credentialing-Due Process-Denial of Contract
State Law

Maine Rev. Statutes-Title 24-A, Chapter 56-A, Subchapter 1. Health Plan Requirements

09/17/2021 Maine Section 4303

Plan requirements

Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Credentialing-Payment Issues, Fee Schedules, Most Favored Nation, Overpayments / Recoupments, Participation in Products, Plans, or Networks, Prohibited financial incentives, Retroactive Denial, Termination, Termination-Due Process
State Law

Dept. of Prof. & Fin. Regulation-Chapter 850-Health Plan Accountability

12/03/2020 Maine Sections 1-10

Purpose; Authority; Applicability and Scope; Affordable Care Act; Definitions; Quality Assurance Standards; Access to Services; Adverse Health Care Treatment Decisions; Grievance Register and Grievance Procedures; Reporting Requirements; Effective Date

Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Network Adequacy, Retroactive Denial, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

Michigan Compiled Laws-Chapter 500. Insurance Code of 1956-Chapter 35. Health Maintenance Organizations

03/20/2021 Michigan Section 500.3531

Contracts with health care providers to become affiliated providers; requirements; standards; filing; duplicative standards; notice procedures; provider application period; approval or rejection as affiliated provider; termination of contract; providing information to insurer.

Credentialing-Due Process-Denial of Contract