§ 58-3-230. Uniform provider credentialing.
§ 58‑3‑230. Uniform provider credentialing.
(a) An insurer thatprovides a health benefit plan and that credentials providers for its networksshall maintain a process to assess and verify the qualifications of a licensedhealth care practitioner within 60 days of receipt of a completed providercredentialing application form approved by the Commissioner. If the insurer hasnot approved or denied the provider credentialing application form within 60days of receipt of the completed application, upon receipt of a written requestfrom the applicant and within five business days of its receipt, the insurershall issue a temporary credential to the applicant if the applicant has avalid North Carolina professional or occupational license to provide the healthcare services to which the credential would apply. The insurer shall not issuea temporary credential if the applicant has reported on the application ahistory of medical malpractice claims, a history of substance abuse or mentalhealth issues, or a history of Medical Board disciplinary action. The temporarycredential shall be effective upon issuance and shall remain in effect untilthe provider's credentialing application is approved or denied by the insurer.When a health care practitioner joins a practice that is under contract with aninsurer to participate in a health benefit plan, the effective date of thehealth care practitioner's participation in the health benefit plan networkshall be the date the insurer approves the practitioner's credentialingapplication.
(b) The Commissionershall by rule adopt a uniform provider credentialing application form that willprovide health benefit plans with the information necessary to adequatelyassess and verify the qualifications of an applicant. The Commissioner mayupdate the uniform provider credentialing application form, as necessary. Noinsurer that provides a health benefit plan may require an applicant to submitinformation that is not required by the uniform provider credentialingapplication form.
(c) As used in thissection, the terms "health benefit plan" and "insurer"shall have the meaning provided under G.S. 58‑3‑167. (2001‑172, s. 1; 2002‑126,s. 6.9(a); 2005‑223, s. 9; 2009‑487, s. 1.)