OK HB2217

Health benefit plans must use uniform credentialing applications and criteria to credential and recredential physicians and other health care providers in Oklahoma.

Plans must notify applicants within 10 calendar days if a credentialing application is incomplete and specify what additional information is needed.

Plans must initiate requests for primary source verification and malpractice history within 7 calendar days of determining an application is complete; malpractice carriers have 21 calendar days to respond.

For "clean applications" (those with no defects or missing documentation), plans have 45 calendar days to complete credentialing; if the application is not clean, the process may be extended up to 180 calendar days total.

Within 31 days after a provider completes credentialing, the health benefit plan must consider the provider in-network for reimbursement purposes; the act becomes effective November 1, 2015.