California § 10144.565 - Except as provided in Section 10144.56, within one year of the operative date of

§ 10144.565. Except as provided in Section 10144.56, within one year of the operative date of

Except as provided in Section 10144.56, within one year of the operative date of this section, a health insurer or its delegate that credentials health care providers for its networks shall make a determination regarding the credentials of a health care provider within 90 days after receiving a completed provider credentialing application, including all required third-party verifications. Upon receipt of the application by the credentialing department, the health insurer or its delegate shall notify the applicant within 10 business days to verify receipt and inform the applicant whether the application is complete. The health insurer shall activate the provider upon successful approval and notify the applicant of the activation within 10 days of approval if the approval occurs prior to the end of the 90-day timeline. The 90-day timeline shall apply only to the credentialing process and does not include contracting completion. If the health insurer or its delegate does not meet the 90-day requirement, the applicant’s credentials shall be provisionally approved for 120 days unless any of the following apply: (a) The applicant is subject to discipline by the licensing entity for that applicant. (b) The applicant has one or more adverse action reports or one or more reports of malpractice payments filed with the National Practitioner Data Bank. (c) The applicant has not been credentialed by the health insurer in the past five years.