With the passage of SB0284, Tennessee physicians and surgeons will now have a new process in place for reimbursement of services during the pendency of a credentialing application before a health insurance entity.
Yarnell Beatty, vice president of Advocacy for the Tennessee Medical Association, said the salient point of the law, found at TCA 56-7-1001, is that “Tennessee commercial health plans are required to provide any medical group practice with which the health plan has an existing contract, a list of all information and supporting documentation required for a credentialing application to be considered complete.”
There is a set timetable by which this must happen; and within five days of receiving the required items, the health insurance entity must inform the applicant if the application is complete or incomplete. If it’s the latter, the insurer must share the information and documentation needed for the application to be considered complete.
“It also allows for a process by which a provider/practice may be paid for claims provided by the applicant during his/her pending credentialing application. This will help medical practices be able to serve the commercial health plans’ enrollees soon after a new physician is hired,” Beatty said.
He noted that previously, there could be a lag time of several months before physicians knew if they had been approved even though providers were eventually credentialed more than 99 percent of the time.
Beatty continued, “It also allows these billion dollar companies to pay for services provided to their enrollees during a pending credentialing application.” Before this new law passed, Beatty said, the plans had little incentive to speed up the process since care was being delivered while costs got kicked down the road.
Signed into law by Gov. Haslam this past May, the law doesn’t go into effect until Jan. 1, 2016.
PHOTOS: Headshot of .
WEB:
TMA: http://www.tnmed.org
RELATED LINKS:
Tennessee General Assembly Bill Search:
