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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

06/15/2020 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

09/17/2021 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

10/27/2020 Indiana Section 27-8-11-13

Fully credentialed provider reimbursement; requirements

Credentialing-Payment Issues
State Law

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

10/27/2020 Indiana Section 27-13-43-3

Provisional credentialing; criteria; reimbursement; termination

Credentialing-Payment Issues
State Law

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

10/27/2020 Indiana Section 27-13-43-4

Fully credentialed provider reimbursement; requirements

Credentialing-Payment Issues
State Law

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

06/30/2020 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

07/01/2020 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

09/21/2021 Louisiana Section 22:1874

Billing by contracted health care providers

Credentialing-Payment Issues, Rental Networks