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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
State Law

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

07/28/2023 Arizona Section 20-3456

Covered services; claims

Credentialing-Payment Issues
State Law

Colorado Rev. Statutes-Title 10-Article 16-Part 7. Consumer Protection Standards Act for the Operation of Managed Care Plans

07/31/2023 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
State Law

Indiana Code-Title 27-Article 8-Chapter 11-Accident and Sickness Insurance─Reimbursement Agreements

07/13/2023 Indiana Sections 27-8-11-1, 27-8-11-4.5, 27-8-11-7, 27-8-11-8, 27-8-11-9, 27-8-11-11, 27-8-11-13

Definitions; Permitted Disclosures by Providers; Coverage of Benefit or Service; Payment of Provider, Application; Provider Credentialing; Provider Directories; Preferred Provider Agreement Prohibitions; Insurer Payment to Insured for Service Rendered by Noncontracted Provider; Requirements; Fully Credentialed Provider Reimbursement; Requirements

Anti-gag clause, Anti-retaliation, Credentialing-Deadlines, Credentialing-Payment Issues, Directories, Most Favored Nation
State Law

Indiana Code-Title 27-Article 13-Chapter 43. Credentialing

07/13/2023 Indiana Sections 27-13-43-2 and 27-13-43-4

Provider Credentialing; Provisional Credentialing, Criteria, Reimbursement, Termination; Fully Credentialed Provider Reimbursement; Requirements

Credentialing-Deadlines, Credentialing-Payment Issues
State Law

Iowa Admin. Code-Insurance Division-Chapter 70. Utilization Review

08/04/2023 Iowa Section 191-70.10(514F)

Credentialing—retrospective payment

Credentialing-Payment Issues
State Law

KY. Rev. Statutes-Chapter 304-Subtitle 17A-Health Benefit Plans-Managed Care Plans

08/05/2023 Kentucky Section 304.17A-576

Notice by managed care plan insurer of health care provider’s application for credentialing–Payments to applicant.

Credentialing-Deadlines, Credentialing-Payment Issues
State Law

LA. Rev. Statutes-Title 22. Insurance

08/07/2023 Louisiana Section 22:1874

Billing by contracted health care providers

Credentialing-Payment Issues, Rental Networks
State Law

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

07/18/2023 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