Source: http://www.wvlegislature.gov/Bill_Text_HTML/2009_SESSIONS/RS/amendments/HB2885%20H%20H&R%20AM%203-9.htm
Timestamp: 2018-01-20 04:17:38
Document Index: 424099315

Matched Legal Cases: ['§16', '§16', '§16', '§16', '§16', '§16', '§16', '§16', '§16', '§16']

HB2885 H H&R AM 3-9
HB2885 H H&HR AM
That §16-1A-1, §16-1A-2, §16-1A-3 and §16-1A-4 of the Code of West Virginia, as amended, be amended and reenacted; and that said code be amended by adding thereto two new sections, designated §16-1A-5 and §16-1A-6, all to read as follows:
(b) The purpose of this article is to authorize the development of uniform credentialing application forms by those public officials regulating the entities that require credentialing and to establish continue an the advisory committee to assist in developing a uniform credentialing process and implementing to implement the use of uniform credentialing through a single credentialing verification organization in this state.
§16-1A-2. Development of uniform credentialing application forms
§16-1A-4. Credentialing Verification Organization.
(a) The department and the commission are hereby given exclusive authorization to execute such contracts as are necessary to carry out the provisions of this article to provide a single CVO in the state that will provide electronic access to the West Virginia uniform credentialing application to all practitioners. The initial contract shall be for a period of five years at which time other credentialing organizations may enter the state. The selected entity shall be the central repository for information required by hospitals, and payers as part of the credentialing process, will verify all information provided by the practitioner, including site visits to the practitioner's office if required by a health plan and will make this information available electronically to hospitals, providers and all payers. The entity will also establish procedures for ensuring that practitioners' files are kept up to date by issuing quarterly reminders for updated information.
(b) The CVO sahll maintain professional and general business liability insurance for the protection of its clients in an amount to be determined by the Secretary and Commissioner and included in the Request for Proposal.
(c) Health care practitioners who are required to be credentialed as well as hospitals, insurance companies, prepaid health plans, managed care organizations, third party administrators and other health care entities who credential their employees shall utilize the services of a single CVO awarded a contract by the department and the commission upon the effectiveness of the CVO. This mandate shall not be effective until and is premised upon:
(2) Accreditation by URAC
(3) Demonstrated compliance with the principles for credentialing verification organizations set forth by the Joint Commission; and
(4)Demonstrated compliance with the Center for Medicare and Medicaid Services Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs.
(d) Each healthcare practitioner is required to use the uniform credentialing application form developed by the advisory committee. Each health care practitioner who is required to be credentialed shall use the CVO created in this article.
(e) Each healthcare practitioner required to use the credentialing verification organization shall be recredentialed every two years on their birthday. Those born in odd years shall be recredentialed in odd years and those born in even years shall be recredentialed in even years. The CVO may make other arrangements consistent with a health care entities' practices and procedures.
(f)Each health care entity which requires credentialing shall accept the credentialing application approved by the Advisory Committee established in section four of this article.
(g) The CVO shall communicate by letter, fax or e-mail a notice of receipt and a notice of any additional documents or information needed to complete the application within twenty-one days of receipt of the application. If the CVO receives any information that is inconsistent with the information that the health care professional provided, the CVO shall request that the professionl rovide clarification of the inconsistency.
(h) Each applicant shall be credentialed within sixty days or no greater than ninety days of the application being deemed complete. The application is deemed complete when all information has been provided by the practitioner and all items have been verified.
(i) If the insurance company takes more than the ninety days to credential a health care practitioner, the insurer is liable for either a civil penalty payable to the provider in the amount of 500 dollars a day, including weekend days, starting at the expiration of the ninety-day period until the credentialing is either approved or denied or retroactive reimbursement to the provider for the services provided from the expiration fot the ninety-day period and the point at which the health care professional is approved or denied. This practice accrues whether or not the practitioner's credentials are accepted by the insurer.
(j) In the additional process of granting privileges, the hospital shall follow their own governing documents for granting privileges.
§16-1A-5. Advisory committee.
(d) The Secretary of the Department of Health and Human Resources and the Insurance Commissioner shall collaborate with the CVO and the advisory committee established above, to update the uniform credentialing form for use by all health care practitioners. In addition, the CAQH and the state uniform credentialing form shall be acceptable.
§16-1A-6. Report required.
On or before the first day of January 1, two thousand two 2010, the secretary of the department of health and human resources and the insurance commissioner department and the commission shall jointly report to the Legislative Oversight Commission on Health and Human Resources Accountability on the need, if any, for further legislation to implement the use of the uniform credentialing application forms form developed pursuant to the legislative rule authorized by section two of this article and the CVO legislation authorized in 2009.