SB 431 — Provider Credentialing/Reimbursement.

FILED SENATE GENERAL ASSEMBLY OF NORTH CAROLINA MarSESSION 28, 2019 S.B.S 1 SENATE BILL 431 Short Title:

431 SESSION 2019 PRINCIPAL CLERK S D SENATE BILL DRS45190-MR-67 Short Title:

Rules and Operations of the Senate April 1, 2019 A BILL TO BE ENTITLED AN ACT TO MAKE AMENDMENTS RELATED TO HEALTH CARE PROVIDER CREDENTIALING BY INSURERS OFFERING HEALTH BENEFIT PLANS AND TO ENSURE REIMBURSEMENT FOR HEALTH CARE PROVIDERS WHILE PROVIDER CREDENTIALING APPLICATIONS ARE BEING PROCESSED.

*DRS45190-MR-67**S431-v-1* General Assembly Of North Carolina Session 2019 An insurer that provides a health benefit plan and that credentials providers for its networks shall establish reasonable protocols and procedures for reimbursing health care provider applicants for covered health care services provided to insureds during the period in which the applicant's competed provider credentialing application is pending, including any health care services provided prior to the issuance of a temporarycredential.

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58-50-217, and provides a covered health care service to a patient who is covered by the health benefit plan for which the provider is awaiting credentialing, and if that health care provider is later denied the credential or otherwise does not contract as part of the health benefit plan's provider network, then the health care provider shall not require that any reimbursement above the amount that would have been required to be paid DRS45190-MR-67Senate Bill 431-First Edition Page 3 General Assembly Of North Carolina Session 2019 by the patient had the provider been in-network with the health benefit plan at the time the services were rendered." SECTION 4.

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