Credentialing; loading; timelines; exception
A. Except as provided in subsection C of this section, the health insurer shall conclude the process of credentialing and loading the applicant’s information into the health insurer’s billing system within one hundred calendar days after the date the health insurer receives a complete application.
B. A health insurer shall provide written or electronic notice of the approval or denial of a credentialing application to an applicant within seven calendar days after the conclusion of the credentialing process.
C. If a licensed health care facility has a delegated credentialing agreement with a health insurer, the health insurer is not responsible for compliance with the timeline prescribed in subsection A of this section for an applicant who works for that facility, but shall conclude the loading process for that applicant within ten calendar days after the health insurer receives a roster of demographic changes related to newly credentialed, terminated or suspended participating providers.