2005 North Carolina Code - General Statutes § 58-3-230. Uniform provider credentialing.

§ 58‑3‑230.  Uniform provider credentialing.

(a)       An insurer that provides a health benefit plan and that credentials providers for its networks shall maintain a process to assess and verify the qualifications of a licensed health care practitioner within 60 days of receipt of a completed provider credentialing application form approved by the Commissioner. When a health care practitioner joins a practice that is under contract with an insurer to participate in a health benefit plan, the effective date of the health care practitioner's participation in the health benefit plan network shall be the date the insurer approves the practitioner's credentialing application.

(b)       The Commissioner shall by rule adopt a uniform provider credentialing application form that will provide health benefit plans with the information necessary to adequately assess and verify the qualifications of an applicant. The Commissioner may update the uniform provider credentialing application form, as necessary. No insurer that provides a health benefit plan may require an applicant to submit information that is not required by the uniform provider credentialing application form.

(c)       As used in this section, the terms "health benefit plan" and "insurer" shall have the meaning provided under G.S. 58‑3‑167. (2001‑172, s. 1; 2002‑126, s. 6.9(a); 2005‑223, s. 9.)