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.
Initial exemption from prior authorization requirements for healthcare providers providing certain healthcare services; Duration of prior authorization exemption; Denial or rescission of prior authorization exemption; Independent review of exemption determination; Effect of appeal of independent review organization determination; Eligibility for prior authorization exemption following
finalized exemption rescission or denial; Effect of prior authorization exemption; Applicability; Prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services; Appeals process for disallowance of prior authorization
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
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.