§ 27-13-43-5 — Provisional credentialing for physicians; conditions

(a) As used in this section, "physician" refers
to an individual who:
(1) is licensed under IC 25-22.5;
(2) has been granted reciprocity by the medical licensing board of
Indiana under IC 25-1-21 before July 1, 2026; or
(3) is licensed in a state that has enacted the interstate medical
licensure compact.
(b) If a physician who is fully credentialed by a health maintenance
organization:
(1) leaves the employment of an employer and becomes employed
with another employer in Indiana; or
(2) establishes or relocates a medical practice in Indiana;
the health maintenance organization shall provisionally credential the
physician for the time frame set forth in subsection (c).
(c) A physician under subsection (b) must be provisionally
credentialed:
(1) for sixty (60) days after the physician's separation from
employment or the establishment or relocation of the medical
practice; or
(2) until the physician is fully credentialed by the health
maintenance organization;
whichever is earlier.
(d) Notwithstanding section 2(j) of this chapter, a health
maintenance organization shall reimburse a physician who is
provisionally credentialed under this section for services rendered
while the physician was provisionally credentialed at the rates
determined by:
(1) the agreement between the physician's new employer and the
health maintenance organization relating to terms and conditions
of reimbursement; or
(2) if:
(A) the physician's new employer has not entered into an
agreement with the health maintenance organization relating to
the terms and conditions of reimbursement; or
(B) the physician established or relocated a medical practice;
the agreement between the physician and the health maintenance
organization relating to terms and conditions of reimbursement
that was in effect at the time of the physician's separation from
employment or the establishment or relocation of the medical
practice.

Legislative History

As added by P.L.215-2025, SEC.66.