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Bill Detail: SB21-126

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Title Timely Credentialing Of Physicians By Insurers
Status Governor Signed (07/06/2021)
Bill Subjects
  • Health Care & Health Insurance
House Sponsors D. Michaelson Jenet (D)
M. Soper (R)
Senate Sponsors R. Fields (D)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 02/25/2021
Summary

The bill requires that when a physician applies to be credentialed
as a participating physician in a health insurance carrier's (carrier's)
provider network, the carrier must conclude the process of credentialing
the applicant within 60 calendar days after the carrier receives the
applicant's completed application. A carrier must provide each applicant
written or electronic notice of the outcome of the applicant's credentialing

within 10 calendar days after the conclusion of the credentialing process.
Within 7 calendar days after a carrier receives an application, the
carrier must provide the applicant a receipt. If a carrier receives an
application but fails to provide the applicant a receipt within 7 calendar
days, the carrier shall consider the applicant a participating physician,
effective no later than 53 calendar days following the carrier's receipt of
the application.
A carrier may not deny a claim for a medically necessary covered
service provided to a covered person if the service:
  • Is a covered benefit under the covered person's health
coverage plan; and
  • Is provided by a participating physician who is in the
provider network for the carrier's health coverage plan and
has concluded the carrier's credentialing process.
A carrier may not require a participating physician to submit an
application or participate in a contracting process in order to be
recredentialed.
A carrier must allow a participating physician to remain
credentialed and include the participating physician in the carrier's
provider network unless the carrier discovers information indicating that
the participating physician no longer satisfies the carrier's guidelines for
participation.
The commissioner of insurance is required to enforce the new
requirements. A carrier that fails to comply with the bill or with any rules
adopted pursuant to the bill is subject to such civil penalties as the
commissioner may order.

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