Rhode Island General Laws Title 27. Insurance § 27-41-87. Health care provider credentialing

(a) For applications received on or after January 1, 2018, a health care entity or health plan operating in the state shall be required to issue a decision regarding the credentialing of a health care provider as soon as practicable, but no later than forty-five (45) calendar days after the date of receipt of a complete credentialing application.

(b) For minor changes to the demographic information of an individual health care provider who is already credentialed with a particular health care entity or health plan, such health care entity or health plan shall complete such change within seven (7) business days of receipt of the health care provider's request. Minor changes to demographic information requested by individual providers shall be submitted in the timeframe, and manner required by the health care entity or health plan, and shall include all supporting documentation required by the particular health care entity or health plan. For purposes of this section, minor changes to the information profile of a health care provider shall include, but not be limited to, changes of address and changes to a health care provider's tax identification number.

(c) Each health care entity or health plan shall establish a written standard defining what elements constitute a complete credentialing application and shall distribute this standard with the written version of the credentialing application and make such standard available on the health care entity's or health plan's website.

(d) Each health care entity or health plan shall respond to inquiries by the applicant regarding the status of an application.

(e) The effective date for billing privileges for health care providers under a particular health care entity or health plan shall be the next business day following the date of approval of the credentialing application.

(f) For applications received from resident graduates on or after January 1, 2018, a health care entity or health plan shall offer a transitional or conditional approval process such that a resident graduate who has submitted an otherwise complete application and met all other criteria, may be conditionally approved, effective upon successful graduation from the training program.

(g) For the purposes of this section, the following definitions apply: