Ohio § 3963.06

§ 3963.06.

(A) If a provider, upon the oral or written request of a contracting entity to submit

a credentialing form, submits a credentialing form that is not complete, the contracting

entity that receives the form shall notify the provider of the deficiency electronically,

by facsimile, or by certified mail, return receipt requested, not later than twenty-one

days after the contracting entity receives the form. (B) If a contracting entity receives any information that is inconsistent with the information

given by the provider in the credentialing form, the contracting entity may request

the provider to submit a written clarification of the inconsistency.  The contracting entity shall send the request described in this division electronically,

by facsimile, or by certified mail, return receipt requested. (C)(1) Except as otherwise provided in division (C)(2) of this section, the credentialing

process under this section starts when a provider initially submits a credentialing

form upon the oral or written request of a contracting entity, and the provider shall

submit the credentialing form to the contracting entity electronically, by facsimile,

or by certified mail, return receipt requested.  Subject to division (C)(3) of this section, a contracting entity shall complete

the credentialing process not later than ninety days after the contracting entity

receives that credentialing form from the provider.  The contracting entity shall allow the provider to submit a credentialing application

prior to the provider's employment.  A contracting entity that does not complete the credentialing process within the

ninety-day period specified in this division is liable for either a civil penalty

payable to the provider in the amount of five hundred dollars per day, including weekend

days, starting at the expiration of that ninety-day period until the provider's credentialing

application is granted or denied or retroactive reimbursement to the provider according

to the terms of the contract for any basic health care services, specialty health

care services, or supplemental health care services the provider provided to enrollees

starting at the expiration of that ninety-day period until the provider's credentialing

application is granted or denied.  When the credentialing process of the contracting entity exceeds the ninety-day

period, the contracting entity shall select the liability to which the contracting

entity is subject and shall inform the provider of the contracting entity's selection. (2) The credentialing process for a medicaid managed care plan starts when the provider

submits a credentialing form and the provider's national provider number issued by

the centers for medicare and medicaid services. (3) The requirement that the credentialing process be completed within the ninety-day

period specified in division (C)(1) of this section does not apply to a contracting

entity if a provider that submits a credentialing form to the contracting entity under

that division is a hospital. (D) Any communication between the provider and the contracting entity shall be electronically,

by facsimile, or by certified mail, return receipt requested. (E) If the state medical board or its agent has primary source verified the medical education,

graduate medical education, and examination history of the physician, or the status

of the physician with the educational commission for foreign medical graduates, if

applicable, the contracting entity may accept the documentation of primary source

verification from the state medical board's web site or from its agent and is not

required to perform primary source verification of the medical education, graduate

medical education, and examination history of the physician or the status of the physician

with the educational commission for foreign medical graduates, if applicable, as a

condition for initially credentialing or recredentialing the physician.