ARIZONA
HOUSE OF REPRESENTATIVES
|
HB 2322: health insurers; provider credentialing |
||
|
PRIME SPONSOR: Representative Carter, LD 15 BILL STATUS: Chaptered |
|
|
Relating to health provider credentialing.
Provisions
Provider Credentialing (Sec. 4)
1. Requires a health insurer to establish a process for a provider to submit a credentialing application electronically.
2. Requires a health insurer to adopt and implement a standard application prior to January 1, 2020.
a. Prescribes specified information that must be included in the application.
3. Directs a health insurer to establish an electronic process for submitting supporting documentation for a credentialing application prior to January 1, 2020.
Credentialing Timelines (Sec. 4)
4. Specifies the credentialing and loading process must conclude within 100 days after a health insurer receives a complete application.
5. Asserts a health insurer must provide notice of an application approval or denial within 7 days after the conclusion of the credentialing process.
6. Specifies a condition in which the health insurer must conclude the loading process within 10 days after receiving a roster of demographic changes.
7. 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.
8. 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.
c. The application is deemed complete if the health insurer does not send a notice within the specified time-period.
9. 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a. Adds a condition that allows a health insurer to deem an application withdrawn.
10. Requires a health insurer to send the applicant a proposed contract upon receipt of a complete application.
11. 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 compliance with the credentialing requirements as provided in the act.
Recredentialing (Sec. 4)
12. Allows a health insurer or its designee to recredential a participating provider at least once every 36 months or more frequently under specified conditions.
a. Stipulates a participating provider remains credentialed and loaded unless the health insurer discovers information that would result in the provider ceasing to meet the health insurer's guidelines for participation.
b. A health insurer must provide the provider a written explanation for the change in status.
Directors of Hospital and Medical Service Corporations (Sec. 3)
13. Removes the requirement for the directors of a corporation to have a representative for administrators or trustees of hospitals contracted with a hospital service corporation or a hospital and medical service corporation to provide hospital services.
14. Eliminates the requirement for the directors of a corporation to include a representative for licensed physicians and surgeons who have a contract with a medical service corporation or a hospital and medical service corporation to provide hospital services.
15. Removes the requirement that a majority of directors of a dental service corporation be contracted dentists.
Miscellaneous
16. Requires a health insurer to correct discrepancies in the provider or network plan directory within 30 days after receiving a discrepancy report from a participating provider.
a. A participating provider must notify the health insurer any change in their information. (Sec. 4)
17. Prohibits a health insurer from denying a claim for covered services by a participating provider if the services are provided after the date of approval of the credentialing application. (Sec. 4)
18. Requires the following nonproprietary information to be available to a credentialing applicant and be posted on its website:
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. (Sec. 4)
19. Directs a health insurer to provide nonproprietary information pertaining to a provider's credentialing application and final decision to the applicant upon request. (Sec. 4)
20. Provides civil immunity to health insurers that comply with the requirements for provider credentialing. (Sec. 4)
21. Prescribes a civil penalty for noncompliance.
a. Directs the Department of Insurance to enforce the requirements for provider credentialing, and to conduct an examination of a health insurer on receipt of multiple complaints of credentialing violations. (Sec. 4)
22. Defines pertinent terms. (Sec. 4)
23. Makes a conforming change. (Sec. 1)
24. Allows a corporation to enter into contracts with licensed hospitals without approval by corporation's board of directors. (Sec. 2)
25. Contains a delayed effective date of January 1, 2019. (Sec. 5)
---------- DOCUMENT FOOTER ---------
Fifty-third Legislature HB 2322
Second Regular Session Version 5: Chaptered
---------- DOCUMENT FOOTER ---------
