Bill Text: MO HB2450 | 2010 | Regular Session | Introduced

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Bill Title: Establishes the Prompt Credentialing Act which requires health carriers to credential certain physicians within 45 days of receiving a completed application or to grant a provisional credentialing status

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-05-14 - Refer: Spec Stand Com on Pro. Registration & Licensing (H) [HB2450 Detail]

Download: Missouri-2010-HB2450-Introduced.html

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SECOND REGULAR SESSION

HOUSE BILL NO. 2450

95TH GENERAL ASSEMBLY

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INTRODUCED BY REPRESENTATIVE KIRKTON.

5453L.01I                                                                                                                                                  D. ADAM CRUMBLISS, Chief Clerk

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AN ACT

To amend chapter 376, RSMo, by adding thereto one new section relating to the prompt credentialing act.

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Be it enacted by the General Assembly of the state of Missouri, as follows:

            Section A. Chapter 376, RSMo, is amended by adding thereto one new section, to be known as section 376.415, to read as follows:

            376.415. 1. This section shall be known and may be cited as the "Prompt Credentialing Act".

            2. As used in this section, the following terms shall mean:

            (1) "Completed application", an application that has been submitted on a uniform credentialing form that does not omit any required information;

            (2) "Credentialing", the process of assessing and validating the qualifications of a licensed practitioner to provide patient care services. The determination is based on an evaluation of the individual's current license, training or experience, current competence, and ability to perform the privileges requested;

            (3) "Health benefit plan", the same meaning as such term is defined in section 376.1350;

            (4) "Health carrier", the same meaning as such term is defined in section 376.1350;

            (5) "Physician", a doctor of osteopathy or allopathic medicine who is licensed to practice medicine in this state under chapter 334.

            3. Every health carrier that credentials physicians in a health benefit plan shall request credentialing information in a uniform format that includes data commonly requested by health carriers for the purpose of credentialing.

            4. Every health carrier shall complete the process of verifying a physician's credentialing information and make a final determination to credential the physician within forty-five calendar days of receipt of a complete application.

            5. If a health carrier does not make a final determination within the time frame established in subsection 4 of this section, the health carrier shall grant the physician provisional credentialing status pending final determination.

            6. Immediately after a physician becomes credentialed, every health carrier shall retroactively compensate physicians for services rendered from the date of his or her application.

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