State Law

New Hampshire Statutes-Title XXXVII-Chapter 420-J: Managed Care Law

08/15/2023 New Hampshire Section 420-J:8-c

Reimbursement for Providers Waiting for Health Carrier Credentialing Verification

Credentialing-Payment Issues

I. Pursuant to RSA 420-J:4, I, health carriers issuing health benefit plans subject to this chapter shall pay claims for covered services rendered to covered persons by a health care provider who, at the time of submission of a clean and complete credentialing application, has a valid license from the respective state licensing board and has been credentialed by the hospital, if appropriate. The claim for covered services rendered by the provider applicant shall be paid at the same contracted rate as the credentialed provider:

(a) When covering on-call for another health care provider who is credentialed by the carrier and billed using the name of the credentialed provider; or

(b) Who, at the time of application, is credentialed by the health carrier in another state or is in the health carrier’s New Hampshire network based on employment with a particular health care entity.

II. For purposes of RSA 420-J:4 and this section, a health care provider having a valid license shall include all:

(a) Mental health practitioners licensed under RSA 330-A and applicants for mental health practice licensure from other states who are permitted to practice in this state pursuant to RSA 330-A:26, II.

(b) Psychologists licensed under RSA 329-B and psychologists licensed in another jurisdiction issued a temporary license to practice under RSA 329-B:20, III.