HB 725-FN - FINAL VERSION
HOUSE BILL 725-FN
SPONSORS: Rep. Knirk, Carr. 3; Rep. Williams, Hills. 4; Rep. Marsh, Carr. 8; Rep. Woods, Merr. 23; Sen. Sherman, Dist 24
COMMITTEE: Commerce and Consumer Affairs
This bill establishes certain credentialing standards and claims quality assurance standards for managed care organizations for the purposes of the Medicaid program.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
7Mar2019... 0487h 19-0737
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
(j)(1) Managed care organizations shall process credentialing applications from all types of providers within the following prescribed time frames:
(A) For primary care physicians, within 30 calendar days of receipt of clean and complete credentialing applications.
(B) For specialty care providers, within 45 calendar days of receipt of clean and complete credentialing applications.
(2) For the purposes of subparagraph (1), the start time begins when the managed care organization has received a provider’s clean and complete application, and ends on the date of the provider’s written notice of network status.
(3) For the purposes of this subparagraph, a “clean and complete” application is a claim that is signed and appropriately dated by the provider, and includes:
(A) Evidence of the provider’s New Hampshire Medicaid identification; and
(B) Other applicable information to support the provider application, including provider explanations related to quality and clinical competence satisfactory to the managed care organization.
(4) If the managed care organization does not process a provider’s credentialing application within the time frames set forth in this subparagraph, the managed care organization shall pay the provider retroactive to 30 calendar days or 45 calendar days after receipt of the provider’s clean and complete application, depending on the prescribed time frame for the appropriate provider.
(5) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to credentialing standards under this subparagraph.
(k)(1) For the purposes of this subparagraph regarding claims quality assurance standards, the commissioner shall adopt the claims definitions established by the Centers for Medicare and Medicaid Services under the Medicaid program which are as follows:
(A) “Clean claim” means a claim that does not have any defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment.
(B) “Incomplete claim” means a claim that is denied for the purpose of obtaining additional information from the provider. The managed care organization shall pay or deny 95 percent of clean claims within 30 days of receipt, or receipt of additional information. The managed care organization shall pay 99 percent of clean claims within 90 days of receipt.
(2) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to claims quality assurance standards under this subparagraph.
Approved: July 10, 2019
Effective Date: September 08, 2019
|Jan. 30, 2019||House||Hearing|
|Feb. 6, 2019||House||Exec Session|
|Feb. 13, 2019||House||Exec Session|
|March 7, 2019||House||Floor Vote|
|April 30, 2019||Senate||Hearing|
|May 15, 2019||Senate||Floor Vote|
|Jan. 3, 2019||Introduced 01/03/2019 and referred to Commerce and Consumer Affairs HJ 3 P. 28|
|Jan. 30, 2019||Public Hearing: 01/30/2019 10:45 am LOB 302|
|Feb. 6, 2019||Subcommittee Work Session: 02/06/2019 09:30 am LOB 104|
|Feb. 6, 2019||==RECESSED== Executive Session: 02/06/2019 02:00 pm LOB 302|
|Feb. 13, 2019||Subcommittee Work Session: 02/13/2019 10:00 am LOB 302|
|Feb. 13, 2019||==CONTINUED== Executive Session: 02/13/2019 02:00 pm LOB 302|
|Retained in Committee|
|March 7, 2019||Committee Report: Ought to Pass with Amendment # 2019-0487h (NT) for 03/07/2019 (Vote 19-1; CC) HC 14 P. 4|
|Committee Report: Ought to Pass with Amendment # 2019-0487h (Vote 19-1; CC)|
|March 7, 2019||Amendment # 2019-0487h (NT): AA VV 03/07/2019 HJ 8 P. 5|
|March 7, 2019||Ought to Pass with Amendment 2019-0487h (NT): MA VV 03/07/2019 HJ 8 P. 5|
|March 14, 2019||Introduced 03/14/2019 and Referred to Commerce; SJ 9|
|April 30, 2019||Hearing: 04/30/2019, Room 102, LOB, 01:30 pm; SC 20|
|May 15, 2019||Committee Report: Ought to Pass, 05/15/2019; Vote 5-0; CC SC 22|
|May 15, 2019||Ought to Pass: MA, VV; OT3rdg; 05/15/2019; SJ 16|
|June 6, 2019||Enrolled (In recess 06/06/2019); SJ 20|
|June 6, 2019||Enrolled 06/06/2019 HJ 18 P. 47|
|July 10, 2019||Signed by Governor Sununu 07/10/2019; Chapter 182; Eff: 09/08/2019|