Health Care Provider Credentialing Applications From the Council on Affordable Quality Healthcare (Caqh)
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A health insurance entity, as defined in § 56-7-109, that credentials or recredentials the providers in its networks shall accept, in addition to its own credentialing and recredentialing applications, the credentialing and recredentialing applications from the Council on Affordable Quality Healthcare (CAQH). If the health insurance entity is a participating organization of CAQH, then the health insurance entity shall accept the application from either CAQH by electronic means or from the provider by electronic means or by a paper copy. If the health insurance entity is not a participating organization of CAQH, then the health insurance entity shall accept the application only from the provider by electronic means or by a paper copy. In either case, the provider shall complete and submit the attestation clause of the health insurance entity before an application is considered complete, if the health insurance entity requires it.
Nothing in this section may be construed to require a health insurance entity to be a participating organization or pay a fee to CAQH.
2005, ch. 167, § 1.
Compiler's Notes. Former §56-7-1009, concerning alcohol and drug treatment, was transferred to §56-7-2602 by Acts 1992, ch. 984, § 4, effective upon the 1994 replacement of this volume.
Any person or entity that is unable to show that it is subject to the jurisdiction of another agency of this or another state or the federal government shall submit to an examination by the commissioner to determine the organization and solvency of the person or the entity, and to determine whether or not the person or entity is in compliance with the applicable provisions of this code.
Any person or entity unable to show that it is subject to the jurisdiction of another agency of this state or another state or the federal government shall be subject to all appropriate provisions of this code regarding the conduct of its business.
Any production agency or administrator, licensed by the department, that advertises, sells, transacts or administers coverage in this state, as described in subsection (a), which is provided by any person or entity described in subsection (c), shall, if that coverage is not fully insured or otherwise fully covered by an admitted life or health insurer, nonprofit hospital service plan corporation, or nonprofit medical service plan corporation, advise any purchaser, prospective purchaser, and covered person of the lack of insurance or other coverage. Any administrator that advertises or administers coverage in this state that is described in subsection (a), that is provided by any person or entity described in subsection (c), shall advise any production agency of the elements of the coverage including the amount of stop-loss insurance in effect.