SEA 43 Health care provider credentialing. Insurance law. Sen. Guard, Breaux; Rep. Ripley, Pelath.
Requires that when an insurer is credentialing a health care provider — in other words, determining whether it will pay for its insured to use the provider — the insurer has to use a form prescribed by the department of insurance. The Department of Insurance is required to use the form used by the Council for Affordable Quality Healthcare.
The insurer is required to notify the health care provider of any deficiencies in the application within 30 days of submission and to provide regular reports on the application status until a final determination is made.
Similar requirements are made for HMOs and their credentialing process. However, the requirements do not apply to HMOs credentialing healthcare providers solely for providing care to Medicaid recipients.
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