Provides comprehensive protections for physicians from health insurer retaliation for both physician communications with patients and communications with regulators/legislators.

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.

Uses most favored nation (MFN) clauses in physician managed-care contracts. Dominant health insurers can force physicians to give discounts to the dominant insurer that the physician may have given to other insurers or payers. This model bill prohibits health insurers from putting MFN clauses in physician contracts.

Ensures that physicians are treated fairly and receive timely payment when they make claims for payment to health insurers and other payers.

Gives physicians due process rights to help protect themselves when health insurers want to give the public information about physicians’ performance.

Requires health insurers to give physicians key payment data and prohibits a health insurer from making a material change to a contract more than once a year.

Ensures that payers give physicians complete and accurate information concerning fee for services reimbursement, as well as a wide variety of risk arrangements, e.g., capitation, to make sure that physicians are fully anticipate expected revenue as well as be empowered to managed successfully any risk they have assumed.

Requires a health insurer to give a physician specific fair process rights, e.g., a hearing, before either officially denying the physician’s request to join an insurer’s network or terminating a physician’s managed care contract or network participation.