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.

Covered services; claims

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

Fully credentialed provider reimbursement; requirements

Fully credentialed provider reimbursement; requirements

Credentialing—retrospective payment

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

Billing by contracted health care providers