(L25, Ch. 97, sec.
3.Eff. 4/1/26)
A.When submitting a credentialing application, a health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the application. The applicant shall include in the application a contact name, telephone number and email address of an individual who can address discrepancies in the application.
B.On receipt of an application, a health insurer shall promptly review the application to determine if the application is complete.
C.Not later than seven calendar days after receipt of a credentialing application, a health insurer shall contact the applicant in writing or by electronic means to acknowledge receipt of the application and inform the applicant whether the applic
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(L25, Ch. 97, sec. 3. Eff. 4/1/26)
A. When submitting a credentialing application, a health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the application. The applicant shall include in the application a contact name, telephone number and email address of an individual who can address discrepancies in the application.
B. On receipt of an application, a health insurer shall promptly review the application to determine if the application is complete.
C. Not later than seven calendar days after receipt of a credentialing application, a health insurer shall contact the applicant in writing or by electronic means to acknowledge receipt of the application and inform the applicant whether the application is a complete credentialing application. If the application is not a complete credentialing application, the notice shall include a detailed list of all of the items required to complete the application. A health insurer may request supplemental information to complete the credentialing process.
D. If the health insurer does not send the notice to the applicant within the required time frame specified in this section, the application is deemed complete for the purposes of section 20-3453.
E. If the health insurer notifies the applicant pursuant to subsection C of this section that the application is not a complete credentialing application, the time periods specified under section 20-3453 are tolled, and the application is suspended from the date the notification was sent to the applicant until the date on which the health insurer receives the information from the applicant to complete the application. Not later than seven calendar days after the applicant submits information to complete the application, the health insurer shall contact the applicant to acknowledge receipt of the additional information and inform the applicant whether the application is a complete credentialing application. If the health insurer has not received any response providing the requested information in subsection C of this section from the applicant after thirty calendar days, the health insurer may deem the application withdrawn and communicate the withdrawal of the application to the applicant within seven calendar days.
F. If at any time during the application process the health insurer tolls the time period specified in section 20-3453 while waiting for additional information from the applicant, the health insurer shall acknowledge receipt of the additional information not later than seven calendar days after the health insurer receives the additional information. The health insurer shall provide all notifications to the applicant in this subsection in writing or by electronic means.
G. A health insurer may not toll the time period specified in section 20-3453 more than three times. If, after the third toll, a health insurer has not received a response from the applicant that includes the requested information as prescribed in subsection C of this section within thirty calendar days, the health insurer may deem the application withdrawn and shall inform the applicant of the withdrawal within seven calendar days.
H. On receipt of a complete credentialing application, a health insurer must send the applicant a proposed contract that is complete and ready for execution by the parties.
I. A health insurer that enters into a delegated credentialing agreement with a licensed health care facility or that participates in a health insurer credentialing alliance with equivalent or higher standards than as prescribed in this section is deemed to be in compliance with the requirements of this section.