DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 257 Engrossed 2015 Regular Session Seabaugh
Abstract: Provides with respect to credentialing, the process of assessing and validating the
qualifications of health care providers applying to be approved by a health insurance issuer
to provide health care services to the health insurance issuer's enrollees or insureds.
Proposed law changes present law authorizing health insurance issuers to require health care
providers to be credentialed, as follows:
(1)Changes the definition of a "health care provider" to specifically include a dentist licensed
to practice dentistry by the La. State Board of Dentistry.
(2)Changes the definition of a "health insurance issuer" to specifically include a dental benefit
plan, including an entity defined as a dental service contractor in present law.
(3)Provides that a provider who has been credentialed by a health insurance issuer for any
location in the state and is current on all credentialing at that location shall be considered
credentialed for all locations at which that provider may legally practice medicine or
dentistry, provided that each of the following conditions are met:
(a)Not less than 30 days prior to the time at which the provider begins practicing at any
additional location, another provider who is current on all credentialing with that
issuer legally practiced there.
(b)The provider gives the issuer written notice of any additional location of practice
beyond his primary practice location and any additional practice location originally
noted on the provider's initial credentialing application form. Allows the issuer to
require that such notice include such additional information as may be reasonably
necessary in order to process claims filed by the provider from the additional
location. Makes the credentialing of the provider for any additional location effective
immediately upon the receipt by the issuer of such written notice from the provider.
(4)Provides that, pursuant to proposed law, there shall be no other requirements placed upon the
provider in order to be credentialed by an issuer for any additional practice location.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1009(A)(intro. para.), (5), and (7); Adds R.S. 22:1009(B)(5) and (6)) Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the original bill:
1. Delete provisions providing that: (a) a provider credentialed by a health insurance issuer
for any location in the state shall be considered credentialed for all locations; (b) it is
necessary only that the credentialed provider give the issuer written notice of any
additional location of practice beyond the primary practice location and any additional
practice location originally noted on the provider's initial credentialing application form;
and (c) any requirement that the provider be recredentialed for such additional locations
shall be prohibited.
2. Add provisions placing specific conditions on a provider to be credentialed for
additional practice locations. Also prohibits any other requirement being placed upon
a provider in order to be credentialed for such an additional location.