UNIFORM GROUP PRACTICE PROVIDER CREDENTIALING.

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View NCGA Bill Details2017-2018 Session
Senate Bill 609 (Public) Filed Tuesday, April 4, 2017
AN ACT TO AMEND THE UNIFORM PROVIDER CREDENTIALING STATUTE TO THOROUGHLY ACCOUNT FOR THE CREDENTIALING OF HEALTH CARE PRACTITIONERS WHO JOIN A GROUP PRACTICE THAT HAS AN EXISTING CONTRACT WITH A HEALTH INSURER.
Intro. by Gunn.

Status: Ref To Com On Rules and Operations of the Senate (Senate Action) (Apr 5 2017)

Bill History:

S 609

Bill Summaries:

  • Summary date: Apr 4 2017 - View Summary

    Amends GS 58-3-230, concerning uniform health care provider credentialing. 

    Adds new subsection (a1), establishing that an insurer that has an existing contract with a group practice to participate in a health benefit plan network and that credentials providers for its networks, must maintain a process to assess and verify the qualifications of a new health care practitioner that joins the group practice within 60 days of receipt of a completed provider credentialing application form approved by the Commissioner of Insurance. Requires the insurer to provide to the group practice a list of all information and supporting documentation required for credentialing a new health care practitioner that joins the practice. Details parameters of the credentialing process for a new health care practitioner that joins a group practice that has an existing contract with an insurer to participate in a health benefit plan, including various notice requirements for an insurer in receipt of a new practitioner application, and provisions regarding claims filed while a credentialing application is pending and upon approval of the application. Makes conforming changes to subsection (a).

    Makes organizational changes to subsection (c). Adds the term existing contract, and defines the term to mean a participating provider agreement between a group practice and an insurer under which practitioners bill for services provided to patients covered by a health benefit plan provided by the insurer. 

    Effective October 1, 2017, and applies to provider credentialing applications received on or after that date.