This bill revises the credentialing process for physicians seeking to join a health insurance carrier's provider network, enhancing transparency and enforcement. It mandates that a carrier's committee must notify applicants within 30 days if their application is incomplete, and if no notification is given, the application is considered complete. Additionally, carriers are required to publish the universal participation and renewal forms on their websites, along with a detailed explanation of the credentialing process, including necessary documents and timelines.

The bill also stipulates that physicians providing healthcare services while awaiting credential approval must be reimbursed for their services from the date their application was filed, provided it is approved. Furthermore, it prohibits carriers from requiring already credentialed physicians to submit new applications solely due to a change in employers or healthcare facilities. Lastly, the Department of Banking and Insurance is empowered to handle complaints and enforce compliance regarding credentialing violations, ensuring that health care professionals have a channel to report issues and that carriers are held accountable for noncompliance.

Statutes affected:
Introduced: 26:2S-7, 26:2S-7.2