HF 1992

as introduced - 91st Legislature (2019 - 2020) Posted on 03/11/2020 03:07pm

A bill for an act
relating to health insurance; establishing requirements for timely provider
credentialing by health plan companies; proposing coding for new law in Minnesota
Statutes, chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.097] REQUIREMENTS FOR TIMELY PROVIDER
CREDENTIALING.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Clean application for provider credentialing" or "clean application" means an
application for provider credentialing submitted by a health care provider to a health plan
company that is complete, is in the format required by the health plan company, and includes
all information and substantiation required by the health plan company.
new text end

new text begin (c) "Clean claim" has the meaning given in section 62Q.75, subdivision 1.
new text end

new text begin (d) "Provider credentialing" means the process undertaken by a health plan company to
evaluate and approve a health care provider's education, training, residency, licenses, and
certifications in order for the health care provider to provide health care services to patients
at a clinic or facility.
new text end

new text begin Subd. 2. new text end

new text begin Time limit for credentialing determination; effect of failure to meet time
limit. new text end

new text begin (a) A health plan company that receives an application for provider credentialing
must:
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new text begin (1) if the application is determined to be a clean application for provider credentialing
and if the health care provider submitting the application or the clinic or facility at which
the health care provider provides services requests the information, affirm that the health
care provider's application is a clean application and notify the health care provider or clinic
or facility of the date by which the health plan company will make a determination on the
health care provider's application;
new text end

new text begin (2) if the application is determined not to be a clean application, inform the health care
provider of the application's deficiencies or missing information or substantiation within
two business days after the health plan company determines the application is not a clean
application; and
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new text begin (3) make a determination on the health care provider's clean application within 30 days
after receiving the clean application.
new text end

new text begin (b) If a health plan company fails to make a determination on a clean application within
30 days after receiving the clean application, the application is deemed approved and the
health care provider is authorized to provide health care services to patients. A health plan
company shall pay clean claims submitted by or on behalf of a health care provider
credentialed under this paragraph according to section 62Q.75.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section applies to applications for provider credentialing
submitted to a health plan company on or after August 1, 2019.
new text end