HB 773 — Health insurance; provider credentialing, receipt of application.

SESSION ENROLLED VIRGINIA ACTS OF ASSEMBLY ––-- 2022 SESSION CHAPTER E471 An Act to amend and reenact § 38.2-3407.10:1 of the Code of Virginia, relating to health insurance;

R O [H 773] Approved LApril L11, 2022 Be it enacted by the General Assembly of Virginia:

E § 38.2-3407.10:1.

Reimbursement for services rendered during pendency of a participating Dprovider's proA.credentialing application.

AsA. used in this section:cation.

"Carrier"As meansused anin entitythis subjectsection: to the insurance laws and regulations of the Commonwealth and subject to the jurisdiction of the Commission that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services or mental health services, including an insurer licensed to sell accident and sickness insurance, a health maintenance organization, a health services plan, or any other entity providing a plan of health insurance, health benefits, health care services, or mental health services.

H"Carrier" "Coveredmeans person"an meansentity asubject policyholder,to subscriber,the enrollee,insurance participant,laws orand otherregulations individua7of coveredthe byCommonwealth "Healthand benefitsubject plan"to meansthe ajurisdiction policy,of contract,the certificate,Commission orthat agreementcontracts offeredor byoffers ato carriercontract to provide, deliver, arrangeincluding for,an payinsurer for,licensed orto reimbursesell accident and sickness insurance, a health maintenance organization, a health services plan, or any ofother theentity costsproviding a plan of health insurance, health benefits, health care services, or mental health services.

R"Covered "Mentalperson" healthmeans professional"a haspolicyholder, thesubscriber, meaningenrollee, ascribedparticipant, theretoor inother §individual 54.1-2400.1.covered by a health benefit plan.

"Health benefit plan" means a policy, contract, certificate, or agreement offered by a carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

"Mental health professional" has the meaning ascribed thereto in § 54.1-2400.1.

submitted"New aprovider completedapplicant" credentialingmeans applicationa tophysician, amental carrier.professional,health professional, or other provider who has "Othersubmitted provider" means a person,completed corporation,credentialing facility,application or institution licensed by the Commonwealth under Title 32.1 or 54.1 to provide health care or professional health-related services on a feecarrier. basis.

"Other provider" means a person, corporation, facility, or institution licensed by the Commonwealth under Title 32.1 or 54.1 to provide health care or professional health-related services on a fee basis.

"Participating other provider" means an other provider who is managed, under contract with, or employed by a carrier and who has agreed to provide such health care or professional services to covered persons with an expectation of receiving payments, other than coinsurance, copayments, or deductibles, directly or indirectly from the carrier.

Board"Physician" ofmeans Medicine.ns a doctor of medicine or osteopathic medicine holding an active license from the B.Board of Medicine.

B.

Permit reimbursement to a new provider applicant for services rendered from the date the new pro3.provider applicant's completed credentialing application is received for consideration by the carrier;

Notwithstanding3. the provisions of subdivision 1 or 4, if the carrier accepts applications through an online credentialing system, require the carrier to recognize notification to a new provider applicant of 2 through the online credentialing system that the provider has submitted and attested to the application as notice by the carrier that the application is received.

IfNotwithstanding the carrierprovisions doesof notsubdivision accept1 or 4, if the carrier accepts applications through an online credentialing system, require the carrier shallto berecognize required,notification withinto 10a daysnew ofprovider receivingapplicant anthrough application,the toonline providecredentialing notificationsystem tothat the new provider applicanthas eithersubmitted byand mailattested orto electronicthe mail,application as selectednotice by the applicant,carrier that the application wasis received;received.

If the carrier does not accept applications of 2 through an online credentialing system, the carrier shall be required, within 10 days of receiving an application, to provide notification to the new provider applicant either by mail or electronic mail, as selected by the applicant, that the application was received;