Section 29. (a) The bureau of managed care shall develop and implement standard credentialing forms for health care providers. A carrier, or any entity that manages or administers benefits for a carrier, shall accept the standard credentialing form for contracting providers as sufficient information necessary to conduct its credentialing process.
(b) The bureau shall promulgate regulations establishing uniform standards and methodologies for credentialing of health care providers. The regulations shall include, but not be limited to, requirements that, for conducting a credentialing review of a health care provider, a carrier, or any entity that manages or administers benefits for a carrier, shall: (i) use and accept only the credentialing forms designated by the commissioner; and (ii) review a submitted credentialing form for a health care provider and respond to the health care provider not more than 20 business days after receiving a completed credentialing request.
Nothing in this section shall prohibit a carrier, or any entity that manages or administers benefits for a carrier, from using a credentialing methodology that utilizes an internet webpage, internet webpage portal or similar electronic, internet and web-based system in lieu of a paper form; provided, however, that upon request, a carrier, or any entity that manages or administers benefits for a carrier, shall make a paper credentialing form available to a health care provider.
(c) A carrier, or an entity that manages or administers benefits for a carrier, that contracts with another entity to perform some or all of the functions governed by this chapter shall be responsible for ensuring that the contracted entity is in compliance with this chapter. The carrier shall be responsible to remedy a failure by the contracted entity to meet the requirements of this chapter and shall be subject to any related enforcement actions, including financial penalties, authorized under this chapter.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176o - Health Insurance Consumer Protections
Section 2 - Bureau of Managed Care
Section 3 - Complaints Against Carriers; Notice; Hearing
Section 5 - Contracts; Liability
Section 5b - Policies and Procedures to Enforce Sec. 5a
Section 5c - Failure of Carrier to Comply With Coding Standards and Guidelines; Notice; Penalty
Section 7 - Information Provided by Carrier Upon Enrollment or Upon Request
Section 8 - Failure by Carrier to File Annual Statement; Fine
Section 9 - Utilization Review Programs; Annual Attestations
Section 10 - Contractual Financial Incentive Plans
Section 11 - Rights of Health Benefit Plans to Include as Providers Religious Non-Medical Providers
Section 12 - Utilization Review
Section 13 - Formal Internal Grievance Process; Expedited Resolution Policy
Section 14 - Review Panel; Patient Protection Office
Section 15 - Disenrollment of Provider; Continuation of Treatment; Specialty Health Care Coverage
Section 17 - Regulations; Promulgation
Section 18 - Responsibility of Carrier for Behavioral Health Services Compliance
Section 21 - Submission by Carrier of Annual Comprehensive Financial Statement
Section 25 - Use and Acceptance of Specifically Designated Prior Authorization Forms