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SB 742 - This act outlines the requirements for a health carrier to credential a health care practitioner within 60 days of receiving a completed application and to pay the practitioner for treatment services pending approval. "Credentialing" is defined as a health carrier's process of assessing and validating the qualifications of a practitioner to provide patient care services and act as a member of the health carrier's provider network. "Completed application" is defined as a practitioner's application to a health carrier that seeks such authorization for the practitioner to provide patient care services as a member of the health carrier's network and does not omit any information which is clearly required by the application form or the accompanying instructions. The sixty-day deadline established in this act shall not apply if the application or subsequent verification of information indicates that the practitioner has: (1) A history of behavioral disorders or other impairments affecting the practitioner's ability to practice, including but not limited to substance abuse; (2) Disciplinary actions against the practitioner's license to practice imposed by any state or territory or foreign jurisdiction; (3) Had the practitioner's hospital admitting or surgical privileges or other organizational credentials or authority to practice revoked, restricted, or suspended based on the practitioner's clinical performance; or (4) A judgment or judicial award against the practitioner arising from a medical malpractice liability lawsuit. The Department of Insurance, Financial Institutions and Professional Registration shall establish a mechanism for reporting alleged violations of this act to the Department. Repeated violations of this act by a health carrier shall constitute an unfair trade practice in the business of insurance. Within 10 business days of receiving a completed application from a practitioner, a health carrier shall permit a practitioner to bill and be paid directly by the insurer for providing treatment services as of the date of receipt of the credentialing application to the enrollees of the health carrier while the credentialing application is under review except under specified limitations which are listed in the act. Some of the limitations include limiting the payment rate, refusing to list the practitioner in a directory or allowing a practitioner to be designated as an enrollee's primary care physician. Nothing in this act shall require a health carrier to pay for treatment services which are excluded from the health carrier's benefit plan. This act is identical to HB 1490 (2012) ADRIANE CROUSE
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