SB 938 - This act modifies provisions relating to the credentialing of health care practitioners by health carriers. This act provides that if a health carrier receives a credentialing application, the carrier shall have ten days from sending notice of the application's receipt to request additional information from the practitioner. The application shall be deemed complete upon receipt of the additional information. Within 2 working days of receipt of the additional information, the carrier shall send notice to the practitioner that the practitioner has submitted a completed application. If the carrier does not request additional information, the application shall be deemed completed as of the date the notice of receipt was sent by the carrier.
The act specifies that the carrier's credentialing decision shall be made within 60 days of receipt of the "completed credentialing application", rather than 60 "business" days of receiving the practitioner's "credentialing information".
If a practitioner's application is approved, the carrier shall provide payments for covered patient care services delivered by the practitioner during the credentialing period, as such terms are defined in the act. A health carrier shall not require a practitioner to be credentialed to receive payments for covered services if the practitioner is providing patient care services, for a period of up to 180 days, on behalf of a credentialed practitioner who is absent as described in the act. Claims payable under these provisions shall be subject to the prompt payment statute.
These provisions are similar to provisions in SS/SCS/HCS/HB 1682 (2020) and provisions in SCS/HB 1383 (2020).
ERIC VANDER WEERD