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.
Credentialing; loading; timelines; exception
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.
Objective criteria for adding or terminating network providers — Termination of contracts — Review process
Provisional Credentialing Status
Provider application for participation and the review panel
Provider Credentialing and Recredentialing
Uniform provider credentialing
Provider application for participation
Minimum fair business standards contract provisions required, processing and payment of health care services, provider claims, commissioner’s jurisdiction
Verification process; suspension of requirements