Note: This version of section effective until 1-1-2024. See also following version of this section, effective 1-1-2024.

     Sec. 9. (a) The office shall implement a centralized credentials verification organization and credentialing process that:

(1) uses a common application, as determined by provider type;

(2) issues a single credentialing decision applicable to all Medicaid programs, except as determined by the office;

(3) recredentials and revalidates provider information not less than once every three (3) years;

(4) requires attestation of enrollment and credentialing information every six (6) months; and

(5) is certificated or accredited by the National Committee for Quality Assurance or its successor organization.

     (b) A managed care organization or contractor of the office may not require additional credentialing requirements in order to participate in a managed care organization’s network. However, a contractor may collect additional information from the provider in order to complete a contract or provider agreement.

     (c) A managed care organization or contractor of the office is not required to contract with a provider.

     (d) A managed care organization or contractor of the office shall:

(1) send representatives to meetings and participate in the credentialing process as determined by the office; and

(2) not require additional credentialing information from a provider if a non-network credentialed provider is used.

     (e) Except when a provider is no longer enrolled with the office, a credential acquired under this chapter is valid until recredentialing is required.

     (f) An adverse action under this section is subject to IC 4-21.5.

     (g) The office may adopt rules under IC 4-22-2 to implement this section.

As added by P.L.195-2018, SEC.5. Amended by P.L.32-2021, SEC.31.