State Codes and Statutes
Statutes > Indiana > Title27 > Ar13 > Ch43IC 27-13-43
Chapter 43. Credentialing
IC 27-13-43-1
Application of chapter
Sec. 1. (a) Except as provided in subsection (b), this chapter
applies to a health maintenance organization that provides basic
health care services.
(b) This chapter does not apply to the credentialing of a provider
by a health maintenance organization if the provider's application for
credentialing is only for purposes of providing health care services
to the following:
(1) A Medicaid recipient under a Medicaid risk based managed
care program described in IC 12-15-12.
(2) An individual who is covered under the children's health
insurance 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 credentialing
application form used by the Council for Affordable Quality
Healthcare (CAQH) in electronic or paper format. The form must be
used by:
(1) a provider who applies for credentialing by a health
maintenance organization; and
(2) a health maintenance organization that performs
credentialing activities.
(b) A health maintenance organization shall notify a provider
concerning a deficiency on a completed credentialing application
form submitted by the provider not later than thirty (30) business
days after the health maintenance organization receives the
completed credentialing application form.
(c) A health maintenance organization shall notify a provider
concerning the status of the provider's completed credentialing
application not later than:
(1) sixty (60) days after the health maintenance organization
receives the completed credentialing application form; and
(2) every thirty (30) days after the notice is provided under
subdivision (1), until the health maintenance organization
makes a final credentialing determination concerning the
provider.
As added by P.L.26-2005, SEC.4. Amended by P.L.1-2006, SEC.489.
