Bill Text: MO HB863 | 2011 | Regular Session | Introduced

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Bill Title: Establishes the Prompt Credentialing Act which requires a health carrier to credential a health care professional within 60 days of receiving a completed application

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2011-04-13 - HCS Voted Do Pass (H) [HB863 Detail]

Download: Missouri-2011-HB863-Introduced.html

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FIRST REGULAR SESSION

HOUSE BILL NO. 863

96TH GENERAL ASSEMBLY

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INTRODUCED BY REPRESENTATIVE FREDERICK.

1980L.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 health care professional 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.

            3. Every health carrier that credentials health care professionals 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. Upon receipt of a completed application, a health carrier or health benefit plan shall send an acknowledgment of the date of receipt of such completed application to the applicant within forty-eight hours if such notice is sent electronically or within five business days if such notice is sent by mail. If electronic notification is available, the health carrier or health benefit plan shall notify the applicant electronically.

            5. Every health carrier shall complete the process of verifying a health care professional's credentialing information and make a final determination to credential the health care professional within sixty calendar days of receipt of a completed application by the health care professional which does not contain any material mistakes that would impede the processing of such application. Such sixty-day period shall include any clerical, administrative, or other activities performed by the health carrier to ensure the health care professional is able to submit claims to the health carrier. Upon expiration of the sixty-day period, the provisions of section 376.383 shall apply for all claims submitted by a health care professional.

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

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