ARIZONA
HOUSE OF REPRESENTATIVES
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HB 2322: health insurers; provider credentialing |
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PRIME SPONSOR: Representative Carter, LD 15 BILL STATUS: Caucus & COW |
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Relating to health provider credentialing.
Provisions
Provider Credentialing (Sec. 1)
1. Requires a health insurer to establish a process for a provider to submit a credentialing or recredentialing application electronically.
2. ADDS THE REQUIREMENT FOR A HEALTH INSURER TO ADOPT AND IMPLEMENT A STANDARD APPLICATION.
a. PRESCRIBES SPECIFIED INFORMATION THAT MUST BE INCLUDED IN THE APPLICATION. (Health)
3. Directs a health insurer to establish an electronic process for a provider to submit supporting documentation and for updating changes to a provider's tax identification number, address, and contact information.
4.
Asserts
that a two-person credentialing committee must review applications.
a. At least one member must be a
provider with knowledge of the applicant's scope of practice. (Health)
Credentialing Timelines (Sec. 1)
5.
Specifies the
credentialing process must conclude within 60
90 days
after a health insurer receives a complete application. (Health)
6. Asserts a health insurer must provide notice of an application approval or denial within 7 days after the conclusion of the credentialing process.
7. Specifies a health insurer must conclude the process of loading the provider's information into the billing system within 10 days after application approval.
8. Specifies a health insurer must provide to the applicant an acknowledgement within 7 days after the health insurer's receipt of the application.
a. Upon receipt, the health insurer must promptly review the application and determine if the application is complete.
9. Stipulates that a health insurer must notify the applicant, within 7 days of receiving an application if the health insurer has determined that the application is incomplete.
a. A detailed list of items required to complete the application must be included in the notice.
b. ALLOWS THE HEALTH INSURER TO REQUEST SUPPLEMENTAL INFORMATION. (Health)
c. The application is deemed complete if the health insurer does not send a notice within the specified time-period.
10. Stipulates certain timelines are tolled and the application is suspended until the health insurer receives information to complete the application if the health insurer properly notified the applicant that the application is incomplete.
a.
The
information requested must be no more than necessary to fairly and responsibly
evaluate the application. (Health)
b. ADDS A CONDITION THAT ALLOWS A HEALTH INSURER TO DEEM AN APPLICATION WITHDRAWN. (Health)
11. REQUIRES A HEALTH INSURER TO SEND THE APPLICANT A COMPLETE CONTRACT EXECUTED BY THE INSURER UPON RECEIPT OF A COMPLETE APPLICATION. (Health)
12. ASSERTS A HEALTH INSURER THAT ENTERS INTO A DELEGATED CREDENTIALING AGREEMENT WITH A LICENSED HEALTH CARE FACILITY WITH EQUIVALENT OR HIGHER STANDARDS IS DEEMED IN COMPLAINCE WITH THE CREDENTIALING REQUIREMENTS AS PROVIDED IN THE ACT. (Health)
Miscellaneous (Sec. 1)
13. Requires a health insurer to correct discrepancies in the provider or network plan within 30 days after receiving a discrepancy report from a participating provider.
a. ADDS THE REQUIREMENT FOR A PARTICIPATING PROVIDE TO NOTIFY THE HEALTH INSURER ANY CHANGE IN THEIR INFORMATION. (Health)
14. Prohibits a health insurer from denying a claim for covered services by a participating provider if the services are provided after the effective date of the contract.
15. Requires the following information to be available to a credentialing applicant AND POST ON ITS WEBSITE (Health):
a. Applicable credentialing policies and procedures;
b. A list of all the information required to be included in an application; and
c. A checklist of materials that must be submitted in the credentialing process.
d. DESIGNATED CONTACT INFORMATION, E-MAIL ADDRESS, AND TELEPHONE NUMBER TO ADDRESS ANY CREDENTIALING INQUIRIES. (Health)
16. Directs a health insurer to provide information pertaining to a provider's credentialing application and final decision to the applicant upon request.
17. Provides civil immunity to health insurers that comply with the requirements for provider credentialing.
18. Prescribes a civil penalty of at least $1,000 and no more than $3,000 per day, for a health insurer who does not comply with credentialing rules or statute.
a. Directs the Department of Insurance to enforce the requirements for provider credentialing.
19. Contains a delayed effective date of January 1, 2019.
20. Defines pertinent terms.
21. MAKES CLARIFYING CHANGES. (Health)
22.
23.
24. ---------- DOCUMENT FOOTER ---------
25. Fifty-third Legislature HB 2322
26. Second Regular Session Version 2: Caucus & COW
27.
28. ---------- DOCUMENT FOOTER ---------
