Sec. 9. (a) The office shall implement a centralized credentials verification organization and credentialing process that:
(1) uses a common application, as determined by provider type;
(2) issues a single credentialing decision applicable to all Medicaid programs, except as determined by the office;
(3) recredentials and revalidates provider information not less than once every three (3) years;
(4) requires attestation of enrollment and credentialing information every six (6) months; and
(5) is certificated or accredited by the National Committee for Quality Assurance or its successor organization.
(b) A managed care organization or contractor of the office may not require additional credentialing requirements in order to participate in a managed care organization's network. However, a contractor may collect additional information from the provider in order to complete a contract or provider agreement.
(c) A managed care organization or contractor of the office is not required to contract with a provider.
(d) A managed care organization or contractor of the office shall:
(1) send representatives to meetings and participate in the credentialing process as determined by the office; and
(2) not require additional credentialing information from a provider if a non-network credentialed provider is used.
(e) Except when a provider is no longer enrolled with the office, a credential acquired under this chapter is valid until recredentialing is required.
(f) An adverse action under this section is subject to IC 4-21.5.
(g) The office may adopt rules under IC 4-22-2 to implement this section.
(h) The office may adopt emergency rules to implement this section. However, an emergency rule adopted under this section expires the earlier of:
(1) one (1) year after the rule was accepted for filing under IC 4-22-2-37.1(e); or
(2) June 30, 2019.
This subsection expires July 1, 2019.
(i) The office shall report the timeliness of determinations made under this section to the legislative council in an electronic format under IC 5-14-6 not later than December 31, 2018. This subsection expires January 1, 2019.
As added by P.L.195-2018, SEC.5.
Copyright ©2024 LegalFix. All rights reserved. LegalFix is not a law firm, is not licensed to practice law, and does not provide legal advice, services, or representation. The information on this website is an overview of the legal plans you can purchase—or that may be provided by your employer as an employee benefit or by your credit union or other membership group as a membership benefit.
LegalFix provides its members with easy access to affordable legal services through a network of independent law firms. LegalFix, its corporate entity, and its officers, directors, employees, agents, and contractors do not provide legal advice, services, or representation—directly or indirectly.
The articles and information on the site are not legal advice and should not be relied upon—they are for information purposes only. You should become a LegalFix member to get legal services from one of our network law firms.
You should not disclose confidential or potentially incriminating information to LegalFix—you should only communicate such information to your network law firm.
The benefits and legal services described in the LegalFix legal plans are not always available in all states or with all plans. See the legal plan Benefit Overview and the more comprehensive legal plan contract during checkout for coverage details in your state.
Use of this website, the purchase of legal plans, and access to the LegalFix networks of law firms are subject to the LegalFix Terms of Service and Privacy Policy.