RÉSUMÉ DIGEST
ACT 63 (HB 257) 2015 Regular Session Seabaugh
New law changes prior law authorizing health insurance issuers to require healthcare
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 existing 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 new 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 the governor (June 5, 2015).
(Amends R.S. 22:1009(A)(intro. para.), (5), and (7); Adds R.S. 22:1009(B)(5) and (6))