health insurers; provider; payment; claims

Reformatted the definition of 'Applicant' to improve readability by adjusting line breaks.

Simplified the description of the nonprofit organization incorporated as a mutual health corporation by removing redundant explanatory text.

Deleted a separate subsection that included credentialing systems operated by dental services corporations, consolidating the definition.

Reformatted notice requirements for incomplete applications to improve readability while maintaining the same substantive obligations.

Adjusted formatting of timeframes for credentialing completion and claim processing to improve clarity.

Corrected minor formatting inconsistencies in statute references and section headers.

Added new Section 20-3454 requiring health insurers to acknowledge receipt of applications within seven calendar days and providing detailed lists of deficiencies if applications are incomplete.

Added new Section 20-3456 requiring health insurers to send proposed contracts to applicants upon receiving complete applications and establishing retroactive payment rules for approved claims.

Added new disclosure requirements in Section 20-3456 requiring providers to inform patients when they are not credentialed or contracted with the insurer.

Changed credentialing completion timeline from 145 days to 60 days, and loading timeline from 145 days to 130 days after receiving a complete application.

Redefined 'Complete credentialing application' to include specific electronic documentation requirements and added a new definition for 'Recredentialing'.

Modified enforcement provisions in Section 20-3459 to give the director authority to conduct examinations of health insurers upon receipt of multiple complaints.

Added new Section 20-3454 with detailed provisions on application acknowledgments, tolling of time periods, and limits on tolling to three times maximum.