HB1372: Credentialing for Medicaid services.

Legislative Summary

Credentialing for Medicaid services. Requires the office of Medicaid policy and planning (office) to prescribe a credentialing application form to be used by: (1) a provider who applies for credentialing by a managed care organization or a contractor of the office (contractor); and (2) a managed care organization or contractor that performs credentialing activities. Requires a managed care organization or contractor to notify a provider concerning: (1) any deficiency in the provider's unclean credentialing application; and (2) the status of the provider's clean credentialing application. Provides that if the managed care organization or contractor fails to issue a credentialing determination within 30 days after receiving a provider's completed credentialing application, the managed care organization or contractor shall provisionally credential the provider if the provider meets certain criteria. Provides that if the managed care organization or contractor fully credentials a provider, then reimbursement payments to the provider shall be paid retroactive to the date on which the initial credentialing application was received and the provider shall be reimbursed at the rates determined by the contract between the provider and the managed care organization or contractor.