Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.
Certification of network plans
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.
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.
Adequacy and Accessibility of Provider Services
Policies or contracts; requirements
Designation as a Preferred Provider, Decision to Withhold Designation, Termination of a Preferred Provider, Review of Process
Provider Credentialing and Recredentialing
Consumer protection and quality requirements for managed care organizations
Selection of participating providers-Credentialing and unfair discrimination