2006 New Hampshire Statutes - Section 420-J:4 Credentialing Verification Procedures.


    I. A health carrier shall:
       (a) Establish written policies and procedures for credentialing verification of all health care professionals with whom the health carrier contracts and apply these standards consistently.
       (b) Verify the credentials of a health care professional before the health care professional with whom the health carrier is contracting provides health services to covered persons. The medical director of the health carrier or other designated health care professional shall have responsibility for, and shall participate in, health care professional credentialing verification.
       (c) Establish a credentialing verification committee consisting of licensed physicians and other health care professionals to review credentialing verification information and supporting documents and make decisions regarding credentialing verification.
       (d) Make available for review by the applying health care professional upon written request all application and credentialing verification policies and procedures.
       (e) Retain records and documents relating to a health care professional's credentialing verification process for 7 years.
       (f) Keep confidential all information obtained in the credentialing verification process, except as otherwise provided by law.
    II. A health carrier shall obtain verification of at least the following information about the applicant:
       (a) Graduation from health care professional school.
       (b) Completion of post graduate training (if applicable).
       (c) The health care professional's license history in this and all other states.
       (d) The health care professional's malpractice history.
       (e) The health care professional's practice history.
       (f) Current license, certificate of authority, or registration to practice a health care profession in New Hampshire.
       (g) Current level of professional liability coverage (if applicable).
       (h) Status of hospital privileges (if applicable).
       (i) Specialty board certification status (if applicable).
       (j) Current Drug Enforcement Agency (DEA) registration certificate (if applicable).
    III. A health carrier shall thereafter obtain, at least every 3 years, verification of a participating provider's:
       (a) Current license, certificate of authority or registration to practice a health care profession in New Hampshire.
       (b) Current level of professional liability coverage (if applicable).
       (c) Status of hospital privileges (if applicable).
       (d) Current DEA registration certificate (if applicable).
       (e) Specialty board certification status (if applicable).
    IV. A health carrier shall require all participating providers to notify the health carrier of changes in the status of any items listed in this section at any time, and shall identify for participating providers the individual or department to whom they should report such changes.
    V. Whenever a health carrier contracts to have another entity perform the credential verification functions required by this section or applicable rules, the commissioner shall hold the health carrier responsible for monitoring the activities of the entity with which it contracts and for ensuring that the requirements of this section and applicable rules are met.
    VI. Nothing in this section shall be construed to require a health carrier to select a health care professional as a participating provider solely because the health care professional meets the health carrier's credentialing verification standards, or to prevent a health carrier from utilizing separate or additional criteria in selecting the health care professionals with whom it contracts.

Source. 1997, 345:1. 2002, 207:41, eff. July 15, 2002.

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