Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice

Title of bill

An act to amend the public health law and the insurance law, in relation to requiring health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice and grant provisional credentials to such professionals

Purpose or general idea of bill

Requires health care plans and insurers to provide expedited review of applications of health care professionals who are joining a group practice.

Summary of specific provisions

Section 1 of the bill amends section 4406-d of the public health law.

Section 2 amends section 4803 of the insurance law.

Section 3 establishes the effective date.

Justification

Currently there is no requirement or incentive for insurance companies to facilitate the timely processing of enrollment applications from participating primary care physician groups for individual providers joining such a group requesting to join the panel. A physician group is defined as a group of one or more physicians which either has a group contract with the insurer, but still may still require individual enrollment, or a group of physicians of which at least one is a participating provider in the plan. These delays make it virtually impossible for the incoming physician to see patients until 60, 90 or even 120 days after the initial application, even while still needing to be a functioning part of the group.

Insurance companies already have such expedited measures for specialists. There are no existing mechanisms for primary care physicians, which can cause up to 6 months of delays in credentialing. Lost revenue, lost physician productivity and untenable working schedules for physicians while waiting for insurance approval make these delays unreasonable. The pressure placed upon physicians groups to bill visits by non-part providers in their group through their part providers is strong, and it is not good sound accounting practice in the long run for either the insurance company or the provider group. Therefore, temporary credentials, expedited enrollment, and expedited change in address from previous practice will all help to increase ease of patient enrollment into the group practice, thereby easing enrollment into the insurance plan as well.

Prior legislative history

2014: A.6426-B - Died on 3rd Rdg. S.4978-B - Died in Health; 2013: A.6426 - Referred to Health; S.4978 - Referred to Health.

Fiscal implications

None.

Effective date

This act shall take effect on April 1, 2017 and shall apply to all applications submitted on or after such date.