§ 20-3454 – Acknowledgement of receipt of an application; notification of incomplete applications
20-3454. Acknowledgement of receipt of an application; notification of incomplete applications A. A health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer’s receipt of the applicant’s application. The applicant shall include in the application a contact name, telephone number and e-mail address to address discrepancies […]
§ 20-3455 – Reported discrepancies; corrective action
20-3455. Reported discrepancies; corrective action A health insurer shall take reasonable steps to correct discrepancies in the provider or network plan directory within thirty calendar days after receiving a written or electronic report of the discrepancy from a participating provider. A participating provider shall notify a health insurer of any change in the provider’s name, […]
§ 20-3456 – Covered services; claims
20-3456. Covered services; claims A health insurer may not deny a claim for a covered service provided to a subscriber by a participating provider who has a fully executed contract with a network plan if the covered services are provided after the date of approval of the credentialing application.
§ 20-3457 – Availability of credentialing information; policies
20-3457. Availability of credentialing information; policies A. A health insurer shall make the following nonproprietary information available to all applicants for credentialing and shall post the information on its website: 1. The applicable credentialing policies and procedures. 2. A list of all the information required to be included in an application. 3. A checklist of […]
§ 20-3458 – Recredentialing
20-3458. Recredentialing A. A health insurer or its designee may recredential participating providers at least once every thirty-six months and more frequently if required by federal or state law or the health insurer’s accreditation standards, or if permitted by the health insurer’s contract with the participating provider. Nothing in this section shall affect the contract […]
§ 20-3459 – Civil immunity; enforcement; civil penalty
20-3459. Civil immunity; enforcement; civil penalty A. A health insurer that complies in good faith with the requirements of this chapter is immune from civil liability for the purposes of reviewing and approving a credentialing application. B. The director shall enforce this chapter. A health insurer that fails to comply with this chapter or with […]
§ 20-3501 – Definitions
20-3501. Definitions In this chapter, unless the context otherwise requires: 1. " Classification of benefits" means the following classifications of benefits provided by a health plan: (a) Inpatient, in-network. (b) Inpatient, out-of-network. (c) Outpatient, in-network. (d) Outpatient, out-of-network. (e) Emergency care. (f) Prescription benefits. 2. " Health care insurer" means a disability insurer, group disability […]
§ 20-3212 – Scope of chapter
20-3212. Scope of chapter This chapter does not: 1. Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law. 2. Prevent or prohibit a person from disclosing voluntarily information concerning life settlement fraud to a law enforcement or regulatory agency other than […]
§ 20-3213 – Applicability
20-3213. Applicability A. A provider lawfully transacting business in this state before the effective date of this chapter may continue to transact business in this state, pending approval or disapproval of that person’s application for a license, if the provider files the application with the director not later than thirty days after publication by the […]
§ 20-3214 – Injunctions; civil remedies; cease and desist
20-3214. Injunctions; civil remedies; cease and desist A. In addition to the penalties and other enforcement provisions of this chapter, if any person violates any provision of this chapter or any rule adopted pursuant to this chapter, the director may seek an injunction in a court of competent jurisdiction in the county where the person […]