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.
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
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
Health care provider credentialing applications—Reimbursement requirements
Provider Credentialing; Provisional Credentialing, Criteria, Reimbursement, Termination; Fully Credentialed Provider Reimbursement; Requirements
Reimbursement for services rendered during pendency of a participating provider’s credentialing application
Covered services; claims
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.
Definitions; Applicability; Eligibility requirements; Payment of applicant physician during credentialing process; Directory entries; Effect of failure to meet credentialing requirements; Enrollee held harmless; Limitation on managed care issuer liability.
Provider Credentialing and Recredentialing