State Laws

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.

State Law

Indiana Code-Title 27-Article 8-Chapter 11-Accident and Sickness Insurance─Reimbursement Agreements

07/13/2023 Indiana Sections 27-8-11-1, 27-8-11-4.5, 27-8-11-7, 27-8-11-8, 27-8-11-9, 27-8-11-11, 27-8-11-13

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

Anti-gag clause, Anti-retaliation, Credentialing-Deadlines, Credentialing-Payment Issues, Directories, Most Favored Nation
State Law

Colorado Rev. Statutes-Title 10-Article 16-Part 7. Consumer Protection Standards Act for the Operation of Managed Care Plans

07/31/2023 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

Revised Code of Washington-Title 48-Chapter 48.43. Insurance Reform

08/28/2023 Washington Section 48.43.757

Health care provider credentialing applications—Reimbursement requirements

Credentialing-Payment Issues
State Law

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

07/13/2023 Indiana Sections 27-13-43-2 and 27-13-43-4

Provider Credentialing; Provisional Credentialing, Criteria, Reimbursement, Termination; Fully Credentialed Provider Reimbursement; Requirements

Credentialing-Deadlines, Credentialing-Payment Issues
State Law

Code of Virginia-Title 38.2-Chapter 34-Article 1. General Provisions

04/07/2023 Virginia Section 38.2-3407.10:1

Reimbursement for services rendered during pendency of a participating provider’s credentialing application

Credentialing-Deadlines, Credentialing-Payment Issues
State Law

Arizona Rev. Statutes-Title 20-Chapter 27-Article 1. General Provisions

07/28/2023 Arizona Section 20-3456

Covered services; claims

Credentialing-Payment Issues
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

Texas Statutes-Insurance Code-Title 8-Subtitle F-Chapter 1452-Subchapter C. Expedited Credentialing Process for Certain Physicians

08/24/2023 Texas Sections 1452.101, 1452.102, 1452.103, 1452.104, 1452.105, 1452.106, 1452.107 and 1452.108

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.

Credentialing-Payment Issues
State Law

Virginia Admin Code-Title 12-Agency 5-Chapter 408. Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees

08/26/2023 Virginia Section 5-408-170

Provider Credentialing and Recredentialing

Credentialing-Deadlines, Credentialing-Patient Demographics, Credentialing-Payment Issues, Termination-Due Process