514F.6 - CREDENTIALING -- RETROSPECTIVE PAYMENT.
514F.6 CREDENTIALING -- RETROSPECTIVE PAYMENT. The commissioner shall adopt rules to provide for the retrospective payment of clean claims for covered services provided by a physician during the credentialing period, once the physician is credentialed. For purposes of this section, "physician" means a licensed doctor of medicine and surgery or a licensed doctor of osteopathic medicine and surgery, and "credentialing period" means the time period between the health insurer's receipt of a physician's application for credentialing and approval of that application by the health insurer. "Credentialing" means a process through which a health insurer makes a determination based on criteria established by the health insurer concerning whether a physician is eligible to provide health care services to an insured and to receive reimbursement for the health care services provided under an agreement entered into between the physician and the health insurer. "Clean claim" means the same as defined in section 507B.4A, subsection 2, paragraph "b".
Section HistorRecent Form 2008 Acts, ch 1123, §28