2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514F - UTILIZATION AND COST CONTROL
514F.6 - CREDENTIALING -- RETROSPECTIVE PAYMENT.

        514F.6  CREDENTIALING -- RETROSPECTIVE PAYMENT.
         The commissioner shall adopt rules to provide for the
      retrospective payment of clean claims for covered services provided
      by a physician during the credentialing period, once the physician is
      credentialed.  For purposes of this section, "physician" means a
      licensed doctor of medicine and surgery or a licensed doctor of
      osteopathic medicine and surgery, and "credentialing period"
      means the time period between the health insurer's receipt of a
      physician's application for credentialing and approval of that
      application by the health insurer.  "Credentialing" means a
      process through which a health insurer makes a determination based on
      criteria established by the health insurer concerning whether a
      physician is eligible to provide health care services to an insured
      and to receive reimbursement for the health care services provided
      under an agreement entered into between the physician and the health
      insurer.  "Clean claim" means the same as defined in section
      507B.4A, subsection 2, paragraph "b".  

         2008 Acts, ch 1123, §28