Ga. Comp. R. & Regs. R. 120-2-83-.05 - Credentialing

(a) Nothing in this Regulation Chapter shall require managed care entities to credential as to nominated providers.

(b) As provided for in O.C.G.A. § 33-20A-9.1(c)(1)(C), managed care entities are permitted to implement credentialing procedures that meet minimum requirements set forth by recognized credentialing bodies.

(c) Within ninety (90) days of receipt of all necessary information as required by the managed care entity and provided with the nomination form in accordance with Rule 120-2-83-.04(a)(l), the managed care entity shall provide notice in writing, to the provider and the enrollee, of the credentialing decision.

(d) For deselected providers, this notice shall contain the specific statutory, medical, professional or ethical reasons for deselection.

Notes

Ga. Comp. R. & Regs. R. 120-2-83-.05

O.C.G.A. Secs. 33-2-9, 33-20A-9.1.

Original Rule entitled "Credentialing" was f. as ER 120-2-83-0.10-.05. F. and eff. on November 24, 1999, the date of adoption, to remain in effect for 120 days or until the effective date of a permanent Rule covering the same subject matter is adopted, as specified by the Agency. Amended: Permanent Rule of same title adopted. F. Mar. 3, 2000; eff. Mar. 23, 2000.