S T A T E O F N E W Y O R K
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8398
2011-2012 Regular Sessions
I N A S S E M B L Y
June 15, 2011
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Introduced by M. of A. RUSSELL -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to provider credentialing
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (a) of section 4803 of the insurance law is
amended by adding a new paragraph 3 to read as follows:
(3) A NEWLY-LICENSED HEALTH CARE PROFESSIONAL, A HEALTH CARE PROFES-
SIONAL WHO HAS RECENTLY RELOCATED TO THIS STATE FROM ANOTHER STATE AND
HAS NOT PREVIOUSLY PRACTICED IN THIS STATE, OR A PHYSICIAN WHO HAS
CHANGED THEIR CORPORATE RELATIONSHIP SUCH THAT IT RESULTS IN THE ISSU-
ANCE OF A NEW TAX IDENTIFICATION NUMBER UNDER WHICH THEIR SERVICES ARE
BILLED FOR, WHO IS EMPLOYED BY A GENERAL HOSPITAL LICENSED PURSUANT TO
ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, WHOSE OTHER EMPLOYED
HEALTH CARE PROFESSIONALS PARTICIPATE IN THE IN-NETWORK PORTION OF AN
INSURER'S NETWORK, SHALL BE DEEMED "PROVISIONALLY CREDENTIALED" UPON THE
PLAN'S RECEIPT OF THE COMPLETED APPLICATION, AND MAY PARTICIPATE IN THE
IN-NETWORK PORTION OF AN INSURER'S NETWORK; PROVIDED, HOWEVER, THAT A
PROVISIONALLY CREDENTIALED PHYSICIAN MAY NOT BE DESIGNATED AS AN
INSURED'S PRIMARY CARE PHYSICIAN UNTIL SUCH TIME AS THE PHYSICIAN HAS
BEEN FULLY CREDENTIALED BY THE PLAN. A HEALTH CARE PROFESSIONAL SHALL
ONLY BE ELIGIBLE FOR PROVISIONAL CREDENTIALING IF THE GENERAL HOSPITAL
LICENSED PURSUANT TO ARTICLE TWENTY-EIGHT OF THE PUBLIC HEALTH LAW WITH
WHICH HE OR SHE IS EMPLOYED NOTIFIES THE INSURER IN WRITING THAT THE
HEALTH CARE PROFESSIONAL HAS BEEN GRANTED HOSPITAL PRIVILEGES AFTER
MEETING THE REQUIREMENTS OF SECTION TWENTY-EIGHT HUNDRED FIVE-K OF THE
PUBLIC HEALTH LAW AND, SHOULD THE APPLICATION ULTIMATELY BE DENIED, THE
LICENSED GENERAL HOSPITAL: (A) SHALL REFUND ANY PAYMENTS MADE BY THE
INSURER FOR IN-NETWORK SERVICES PROVIDED BY THE PROVISIONALLY CREDEN-
TIALED HEALTH CARE PROFESSIONAL THAT EXCEED ANY OUT-OF-NETWORK BENEFITS
PAYABLE UNDER THE INSURED'S CONTRACT WITH THE INSURER; AND (B) SHALL NOT
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD11200-01-1
A. 8398 2
PURSUE REIMBURSEMENT FROM THE INSURED, EXCEPT TO COLLECT THE COPAYMENT
OR COINSURANCE THAT OTHERWISE WOULD HAVE BEEN PAYABLE HAD THE INSURED
RECEIVED SERVICES FROM A HEALTH CARE PROFESSIONAL PARTICIPATING IN THE
IN-NETWORK PORTION OF AN INSURER'S NETWORK.
S 2. This act shall take effect on the ninetieth day after it shall
have become a law, and shall apply to applications submitted after such
date and shall not apply to applications submitted prior to such date if
such application is resubmitted in substantially similar form on or
after the effective date of this act.