NC S609

Amends the provider credentialing statute to establish a separate 60-day credentialing process for health care practitioners who join group practices that already have contracts with health insurers.

Requires insurers to notify applicants within 5 business days whether credentialing applications are complete or incomplete, and applicants have 30 calendar days to submit missing information or the application is automatically denied.

Prohibits new practitioners from submitting claims for reimbursement while their credentialing application is pending; upon approval, previously held claims must be submitted and paid at the contracted in-network rate retroactive to the date the complete application was received.

Specifies that insurers are not obligated to pay claims at in-network rates if the application is denied, and group practices must refund reimbursement obtained through fraudulent credentialing approval and cannot collect amounts from patients for such denied or refunded services.

Effective October 1, 2017, for provider credentialing applications received on or after that date.