• The Ohio Healthcare Simplification Act: Impact on Credentialing
  • May 5, 2009 | Author: Thomas D. Anthony
  • Law Firms: Frost Brown Todd LLC - Office ; Frost Brown Todd LLC - Office
  • The Ohio Healthcare Simplification Act (HB 125) was signed into Ohio law on March 25, 2008, codified as ORC 3963 and was enacted to achieve two main goals: (1) to improve the contracting process between healthcare providers and insurers and (2) to standardize the credentialing process that insurers require of healthcare providers.

    The Act creates a standardized credentialing process to be used by insurers to select healthcare providers in Ohio. Under the Act, all physicians and other healthcare providers will be subject to only one credentialing process for insurance credentialing. Physicians can now fill out one credentialing form, the Council for Affordable Quality Healthcare (CAQH) form. The Act also directs the Department of Insurance to adopt a simple and straightforward application form for all other types of healthcare providers. All insurers are required to use this form and will not be permitted to tack on additional questions.

    If there are any deficiencies with a healthcare provider’s credentialing form, the insurers must notify the healthcare provider within 21 days from the date the credentials were submitted. Further, the insurer must accept or deny the healthcare provider’s credentials within 90 days or it will have to pay penalties. Specifically, the insurer must either pay the healthcare provider $500 per day for each day over the 90-day period that it takes to grant or deny a credentialing application, or the insurer must reimburse the healthcare provider under the terms of the contract for any services provided after 90 days until the insurer finishes the credentialing process. The new credentialing process does not apply to hospitals which are credentialing physicians. For Medicaid managed care programs, credentialing timelines do not begin to run until the National Provider Number is submitted along with the credentialing form.