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Session Laws, 1999
Volume 796, Page 3386   View pdf image
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(II) "CARRIER" INCLUDES AN ENTITY THAT ARRANGES A PROVIDER
PANEL FOR A CARRIER

(3) "CREDENTIALING INTERMEDIARY" MEANS A PERSON TO WHOM A
CARRIER HAS DELEGATED CREDENTIALING OR RECREDENTIALS AUTHORITY AND
RESPONSIBILITY

(4) "HEALTH CARE PROVIDER" MEANS AN INDIVIDUAL WHO IS
LICENSED, CERTIFIED, OR OTHERWISE AUTHORIZED UNDER THE HEALTH
OCCUPATIONS ARTICLE TO PROVIDE HEALTH CARE SERVICES.

(5) "PROVIDER PANEL" MEANS THE PROVIDERS THAT CONTRACT WITH A
CARRIER TO PROVIDE HEALTH CARE SERVICES TO THE ENROLLEES UNDER A
HEALTH BENEFIT PLAN OF THE CARRIER

(6) "UNIFORM CREDENTIALING FORM" MEANS THE FORM DESIGNATED
BY THE COMMISSIONER THROUGH REGULATION FOR USE BY A CARRIER OR ITS
CREDENTIALING INTERMEDIARY FOR CREDENTIALING AND RECREDENTIALS A
HEALTH CARE PROVIDER FOR PARTICIPATION ON A PROVIDER PANEL.

(B) (1) A CARRIER OR ITS CREDENTIALING INTERMEDIARY SHALL ACCEPT
THE UNIFORM CREDENTIALING FORM AS THE SOLE APPLICATION FOR A HEALTH
CARE PROVIDER TO BECOME CREDENTIALED OR RECREDENTIALED FOR A PROVIDER
PANEL OF THE CARRIER

(2) A CARRIER OR ITS CREDENTIALING INTERMEDIARY SHALL MAKE
THE UNIFORM CREDENTIALING FORM AVAILABLE TO ANY HEALTH CARE PROVIDER
THAT IS TO BE CREDENTIALED OR RECREDENTIALED BY THAT CARRIER OR
CREDENTIALING INTERMEDIARY.

(C) THE COMMISSIONER MAY IMPOSE A PENALTY NOT TO EXCEED $500
AGAINST ANY CARRIER OR ITS CREDENTIALING INTERMEDIARY FOR EACH
VIOLATION OF THIS SECTION BY THE CARRIER OR ITS CREDENTIALING
INTERMEDIARY.

(D) (1) THE COMMISSIONER SHALL ADOPT REGULATIONS TO IMPLEMENT
THE PROVISIONS OF THIS SECTION.

(2) IN ADOPTING THE REGULATIONS REQUIRED UNDER PARAGRAPH (1)
OF THIS SUBSECTION, THE COMMISSIONER SHALL CONSIDER THE USE OF AN
ELECTRONIC FORMAT FOR THE UNIFORM CREDENTIALING FORM AND THE FILING
OF THE UNIFORM CREDENTIALING FORM BY ELECTRONIC MEANS.
SECTION 2. AND BE IT FURTHER ENACTED, That:

(a) There is a Task force to Develop a Uniform Credentialing Form consisting
of 15 members
;

(b) The membership of the Task Force consists of:

(1) three representatives from the Medical Group Management
Association;


 

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Session Laws, 1999
Volume 796, Page 3386   View pdf image
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