*HB1372.1*
January 24, 2023
HOUSE BILL No. 1372
_____
DIGEST OF HB 1372 (Updated January 24, 2023 11:22 am - DI 147)
Citations Affected: IC 12-15.
Synopsis: Credentialing for Medicaid services. Requires the office of
Medicaid policy and planning (office) to prescribe a credentialing
application form to be used by: (1) a provider who applies for
credentialing by a managed care organization or a contractor of the
office (contractor); and (2) a managed care organization or contractor
that performs credentialing activities. Requires a managed care
organization or contractor to notify a provider concerning: (1) any
deficiency in the provider's unclean credentialing application; and (2)
the status of the provider's clean credentialing application. Provides
that if the managed care organization or contractor fails to issue a
credentialing determination within 30 days after receiving a provider's
completed credentialing application, the managed care organization or
contractor shall provisionally credential the provider if the provider
meets certain criteria. Provides that if the managed care organization
or contractor fully credentials a provider, then reimbursement payments
to the provider shall be paid retroactive to the date on which the initial
credentialing application was received and the provider shall be
reimbursed at the rates determined by the contract between the
provider and the managed care organization or contractor.
Effective: July 1, 2023.
King, Barrett, Schaibley
January 17, 2023, read first time and referred to Committee on Public Health.
January 24, 2023, amended, reported — Do Pass.
HB 1372—LS 7370/DI 55 January 24, 2023
First Regular Session of the 123rd General Assembly (2023)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2022 Regular Session of the General Assembly.
HOUSE BILL No. 1372
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-15-11-10 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2023]: Sec. 10. (a) As used in this section,
4 "clean credentialing application" means an application for
5 network participation that:
6 (1) is submitted by a provider under this section;
7 (2) does not contain an error; and
8 (3) may be processed by the managed care organization or
9 contractor of the office without returning the application to
10 the provider for a revision or clarification.
11 (b) As used in this section, "credentialing" means a process by
12 which a managed care organization or contractor of the office
13 makes a determination that:
14 (1) is based on criteria established by the managed care
15 organization or contractor of the office; and
16 (2) concerns whether a provider is eligible to:
17 (A) provide health services to an individual eligible for
HB 1372—LS 7370/DI 55 2
1 Medicaid services; and
2 (B) receive reimbursement for the health services;
3 under an agreement that is entered into between the provider
4 and managed care organization or contractor of the office.
5 (c) As used in this section, "unclean credentialing application"
6 means an application for network participation that:
7 (1) is submitted by a provider under this section;
8 (2) contains at least one (1) error; and
9 (3) must be returned to the provider to correct the error.
10 (d) This section applies to a managed care organization or a
11 contractor of the office.
12 (e) The office shall prescribe the credentialing application form
13 used by the Council for Affordable Quality Healthcare in
14 electronic or paper format, which must be used by:
15 (1) a provider who applies for credentialing by a managed
16 care organization or a contractor of the office; and
17 (2) a managed care organization or a contractor of the office
18 that performs credentialing activities.
19 (f) A managed care organization or contractor of the office shall
20 notify a provider concerning a deficiency on a completed unclean
21 credentialing application form submitted by the provider not later
22 than thirty (30) business days after the entity receives the
23 completed unclean credentialing application form. A notice
24 described in this subsection must:
25 (1) provide a description of the deficiency; and
26 (2) state the reason why the application was determined to be
27 an unclean credentialing application.
28 (g) A managed care organization or contractor of the office shall
29 notify a provider concerning the status of the provider's completed
30 clean credentialing application not later than:
31 (1) sixty (60) days after the entity receives the completed clean
32 credentialing application form; and
33 (2) every thirty (30) days after the notice is provided under
34 subdivision (1), until the entity makes a final credentialing
35 determination concerning the provider.
36 (h) Notwithstanding subsection (g), if the managed care
37 organization or contractor of the office fails to issue a credentialing
38 determination within thirty (30) days after receiving a completed
39 credentialing application form from a provider, the managed care
40 organization or contractor of the office shall provisionally
41 credential the provider if the provider meets the following criteria:
42 (1) The provider has submitted a completed and signed clean
HB 1372—LS 7370/DI 55 3
1 credentialing application form and any required supporting
2 material to the managed care organization or contractor of
3 the office.
4 (2) The provider was previously credentialed by the managed
5 care organization or contractor of the office in Indiana and in
6 the same scope of practice for which the provider has applied
7 for provisional credentialing or the provider is a member of
8 a provider group or health facility that is credentialed and a
9 participating provider with the managed care organization or
10 the contractor of the office.
11 (i) The criteria for issuing provisional credentialing under
12 subsection (h) may not be less stringent than the standards and
13 guidelines governing provisional credentialing from the National
14 Committee for Quality Assurance or its successor organization.
15 (j) Once a managed care organization or the contractor of the
16 office fully credentials a provider that holds provisional
17 credentialing and a network provider agreement has been
18 executed, then reimbursement payments under the contract shall
19 be paid retroactive to the date the initial credentialing application
20 was received. The managed care organization or contractor of the
21 office shall reimburse the provider at the rates determined by the
22 contract between the provider and the:
23 (1) managed care organization; or
24 (2) contractor of the office.
25 (k) If a managed care organization or contractor of the office
26 does not fully credential a provider that is provisionally
27 credentialed under subsection (h), the provisional credentialing is
28 terminated on the date the managed care organization or
29 contractor of the office notifies the provider of the adverse
30 credentialing determination. The managed care organization or
31 contractor of the office is not required to reimburse for services
32 rendered while the provider was provisionally credentialed.
HB 1372—LS 7370/DI 55 4
COMMITTEE REPORT
Mr. Speaker: Your Committee on Public Health, to which was
referred House Bill 1372, has had the same under consideration and
begs leave to report the same back to the House with the
recommendation that said bill be amended as follows:
Page 1, line 3, delete "After a provider who is an" and insert "As
used in this section, "clean credentialing application" means an
application for network participation that:
(1) is submitted by a provider under this section;
(2) does not contain an error; and
(3) may be processed by the managed care organization or
contractor of the office without returning the application to
the provider for a revision or clarification.
(b) As used in this section, "credentialing" means a process by
which a managed care organization or contractor of the office
makes a determination that:
(1) is based on criteria established by the managed care
organization or contractor of the office; and
(2) concerns whether a provider is eligible to:
(A) provide health services to an individual eligible for
Medicaid services; and
(B) receive reimbursement for the health services;
under an agreement that is entered into between the provider
and managed care organization or contractor of the office.
(c) As used in this section, "unclean credentialing application"
means an application for network participation that:
(1) is submitted by a provider under this section;
(2) contains at least one (1) error; and
(3) must be returned to the provider to correct the error.
(d) This section applies to a managed care organization or a
contractor of the office.
(e) The office shall prescribe the credentialing application form
used by the Council for Affordable Quality Healthcare in
electronic or paper format, which must be used by:
(1) a provider who applies for credentialing by a managed
care organization or a contractor of the office; and
(2) a managed care organization or a contractor of the office
that performs credentialing activities.
(f) A managed care organization or contractor of the office shall
notify a provider concerning a deficiency on a completed unclean
credentialing application form submitted by the provider not later
than thirty (30) business days after the entity receives the
HB 1372—LS 7370/DI 55 5
completed unclean credentialing application form. A notice
described in this subsection must:
(1) provide a description of the deficiency; and
(2) state the reason why the application was determined to be
an unclean credentialing application.
(g) A managed care organization or contractor of the office shall
notify a provider concerning the status of the provider's completed
clean credentialing application not later than:
(1) sixty (60) days after the entity receives the completed clean
credentialing application form; and
(2) every thirty (30) days after the notice is provided under
subdivision (1), until the entity makes a final credentialing
determination concerning the provider.
(h) Notwithstanding subsection (g), if the managed care
organization or contractor of the office fails to issue a credentialing
determination within thirty (30) days after receiving a completed
credentialing application form from a provider, the managed care
organization or contractor of the office shall provisionally
credential the provider if the provider meets the following criteria:
(1) The provider has submitted a completed and signed clean
credentialing application form and any required supporting
material to the managed care organization or contractor of
the office.
(2) The provider was previously credentialed by the managed
care organization or contractor of the office in Indiana and in
the same scope of practice for which the provider has applied
for provisional credentialing or the provider is a member of
a provider group or health facility that is credentialed and a
participating provider with the managed care organization or
the contractor of the office.
(i) The criteria for issuing provisional credentialing under
subsection (h) may not be less stringent than the standards and
guidelines governing provisional credentialing from the National
Committee for Quality Assurance or its successor organization.
(j) Once a managed care organization or the contractor of the
office fully credentials a provider that holds provisional
credentialing and a network provider agreement has been
executed, then reimbursement payments under the contract shall
be paid retroactive to the date the initial credentialing application
was received. The managed care organization or contractor of the
office shall reimburse the provider at the rates determined by the
contract between the provider and the:
HB 1372—LS 7370/DI 55 6
(1) managed care organization; or
(2) contractor of the office.
(k) If a managed care organization or contractor of the office
does not fully credential a provider that is provisionally
credentialed under subsection (h), the provisional credentialing is
terminated on the date the managed care organization or
contractor of the office notifies the provider of the adverse
credentialing determination. The managed care organization or
contractor of the office is not required to reimburse for services
rendered while the provider was provisionally credentialed.".
Page 1, delete lines 4 through 17.
Delete page 2.
and when so amended that said bill do pass.
(Reference is to HB 1372 as introduced.)
BARRETT
Committee Vote: yeas 13, nays 0.
HB 1372—LS 7370/DI 55