§ 20-3458 — Recredentialing

A. A health insurer or its designee may recredential participating providers at least once every thirty-six months and more frequently if required by federal or state law or the health insurer's accreditation standards, or if permitted by the health insurer's contract with the participating provider. Nothing in this section shall affect the contract termination rights of a health insurer or a participating provider.

B. A participating provider remains credentialed and loaded in the health insurer's billing system unless the health insurer discovers information that would result in the participating provider ceasing to meet the health insurer's guidelines for participation, in which case the health insurer shall provide the participating provider a written explanation for the change in status.