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ARC Advocacy Resources
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
ARC Advocacy Resources
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.
Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Patient Demographics, Directories, Model Legislation, Network Adequacy, Prohibited financial incentives, Termination
State Law
07/28/2023
California
Section 2240.1
Adequacy and Accessibility of Provider Services
Credentialing-Patient Demographics, Network Adequacy
State Law
07/16/2023
Connecticut
Section 38a-472f
Network adequacy. Health carrier duties and responsibilities. Access plan filing.
Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Patient Demographics, Network Adequacy, Participation in Products, Plans, or Networks, Profiling, Prohibited financial incentives, Termination
State Law
08/01/2023
Delaware
Section 1403-11.0
Quality Assurance and Operations
Credentialing-Patient Demographics, Network Adequacy, Retroactive Denial, U.R. Criteria
State Law
08/02/2023
Hawaii
Section 431:26-104
Requirements for health carriers and participating providers
Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Patient Demographics, Profiling, Termination
State Law
08/05/2023
Kentucky
Section 304.17A-525
Standards for provider participation; Mechanisms for consideration of provider applications; Policy for removal or withdrawal
Credentialing-Patient Demographics, Profiling, Termination, Termination-Due Process
State Law
07/10/2020
Mississippi
Sections 14.01-14.13
Managed care plan network adequacy
Anti-gag clause, Anti-retaliation, Credentialing-Patient Demographics, Fee Schedules, Liability-insurer shifting to physician, Network Adequacy, Prohibited financial incentives, Termination
State Law
08/09/2023
Missouri
Section 354.606
Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department.
Anti-gag clause, Anti-retaliation, Credentialing-Patient Demographics, Prohibited financial incentives
State Law
08/10/2023
Montana
Section 33-36-203
Selection of providers-professional credentials standards
Credentialing-Patient Demographics
