A red-lined version of the NAIC’s model bill to assist medical societies in states where the NAIC model has been introduced or where the medical society would like to propose network adequacy legislation.
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.
Adequacy and Accessibility of Provider Services
Network adequacy. Health carrier duties and responsibilities. Access plan filing.
Quality Assurance and Operations
Requirements for health carriers and participating providers
Standards for provider participation; Mechanisms for consideration of provider applications; Policy for removal or withdrawal
Managed care plan network adequacy
Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department.
Selection of providers-professional credentials standards