CHAPTER 43. CREDENTIALING

IC 27-13-43
    Chapter 43. Credentialing

IC 27-13-43-1
Application of chapter
    Sec. 1. (a) Except as provided in subsection (b), this chapterapplies to a health maintenance organization that provides basichealth care services.
    (b) This chapter does not apply to the credentialing of a providerby a health maintenance organization if the provider's application forcredentialing is only for purposes of providing health care servicesto the following:
        (1) A Medicaid recipient under a Medicaid risk based managedcare program described in IC 12-15-12.
        (2) An individual who is covered under the children's healthinsurance program established under IC 12-17.6-2.
As added by P.L.26-2005, SEC.4.

IC 27-13-43-2
Provider credentialing
    Sec. 2. (a) The department shall prescribe the credentialingapplication form used by the Council for Affordable QualityHealthcare (CAQH) in electronic or paper format. The form must beused by:
        (1) a provider who applies for credentialing by a healthmaintenance organization; and
        (2) a health maintenance organization that performscredentialing activities.
    (b) A health maintenance organization shall notify a providerconcerning a deficiency on a completed credentialing applicationform submitted by the provider not later than thirty (30) businessdays after the health maintenance organization receives thecompleted credentialing application form.
    (c) A health maintenance organization shall notify a providerconcerning the status of the provider's completed credentialingapplication not later than:
        (1) sixty (60) days after the health maintenance organizationreceives the completed credentialing application form; and
        (2) every thirty (30) days after the notice is provided undersubdivision (1), until the health maintenance organizationmakes a final credentialing determination concerning theprovider.
As added by P.L.26-2005, SEC.4. Amended by P.L.1-2006, SEC.489.