GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	2
HOUSE BILL 1160
Committee Substitute Favorable 4/24/01

Short Title:	Health Ins./Uniform Provider Credentialing.	()	
Sponsors:	     	
Referred to:	     	
April 12, 2001

A BILL TO BE ENTITLED
AN ACT TO PROVIDE FOR UNIFORM PROVIDER CREDENTIALING BY HEALTH INSURANCE PLANS. 

The General Assembly of North Carolina enacts:
SECTION 1.  Article 3 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-3-230. Uniform provider credentialing.
(a)	An insurer that provides a health benefit plan shall maintain a process to assess and verify the qualifications of a licensed health care practitioner, or applicant for licensure as a health care practitioner, within 60 days of receipt of a completed provider application form approved by the Commissioner.
(b)	The Commissioner shall by rule adopt a uniform provider credentialing application form that will provide credentialing entities with the information necessary to adequately assess and verify the qualifications of an applicant. No insurer that provides a health benefit plan may require an applicant to submit information that is not required by the uniform provider credentialing application form.
(c)	As used in this section, the terms 'health benefit plan' and 'insurer' shall have the meaning provided under G.S. 58-3-167."
SECTION 2.  G.S. 58‑65‑2 reads as rewritten:
"§ 58‑65‑2.  Other laws applicable to service corporations.
The following provisions of this Chapter are applicable to service corporations that are subject to this Article:
G.S. 58‑2‑125.	Authority over all insurance companies; no exemptions from license.
G.S. 58‑2‑155.	Investigation of charges.
G.S. 58‑2‑160.	Reporting and investigation of insurance and reinsurance fraud and the financial condition of licensees; immunity from liability.
G.S. 58‑2‑162.	Embezzlement by insurance agents, brokers, or administrators.
G.S. 58‑2‑185.	Record of business kept by companies and agents; Commissioner may inspect.
G.S. 58‑2‑190.	Commissioner may require special reports.
G.S. 58‑2‑195.	Commissioner may require records, reports, etc., for agencies, agents, and others.
G.S. 58‑2‑200.	Books and papers required to be exhibited.
G.S. 58‑3‑50.	Companies must do business in own name; emblems, insignias, etc.
G.S. 58‑3‑115.	Twisting with respect to insurance policies; penalties.
G.S. 58-3-230.	Uniform provider credentialing.
G.S. 58‑50‑35.	Notice of nonpayment of premium required before forfeiture.
G.S. 58‑51‑25.	Policy coverage to continue as to mentally retarded or physically handicapped children."
SECTION 3.  G.S. 58‑67‑171 reads as rewritten:
"§ 58‑67‑171.  Other laws applicable to HMOs.
The following provisions of this Chapter are applicable to HMOs that are subject to this Article:
G.S. 58‑2‑125.	Authority over all insurance companies; no exemptions from license.
G.S. 58‑2‑155.	Investigation of charges.
G.S. 58‑2‑160.	Reporting and investigation of insurance and reinsurance fraud and the financial condition of licensees; immunity from liability.
G.S. 58‑2‑162.	Embezzlement by insurance agents, brokers, or administrators.
G.S. 58‑2‑185.	Record of business kept by companies and agents; Commissioner may inspect.
G.S. 58‑2‑190.	Commissioner may require special reports.
G.S. 58‑2‑195.	Commissioner may require records, reports, etc., for agencies, agents, and others.
G.S. 58‑2‑200.	Books and papers required to be exhibited.
G.S. 58‑3‑50. 	Companies must do business in own name; emblems, insignias, etc.
G.S. 58‑3‑115.	Twisting with respect to insurance policies; penalties.
G.S. 58-3-230.	Uniform provider credentialing.
G.S. 58‑50‑35.	Notice of nonpayment of premium required before forfeiture.
G.S. 58‑51‑25.	Policy coverage to continue as to mentally retarded or physically handicapped children.
G.S. 58‑51‑35.	Insurers and others to afford coverage to mentally retarded and physically handicapped children.
G.S. 58‑51‑45.	Policies to be issued to any person possessing the sickle‑cell trait or hemoglobin C trait."
SECTION 4.  This act becomes effective October 1, 2001.