Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-83 - CONSUMER CHOICE OPTION
Rule 120-2-83-.05 - Credentialing
Current through Rules and Regulations filed through September 23, 2024
(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.
O.C.G.A. Secs. 33-2-9, 33-20A-9.1.
