20-3454. Acknowledgement of receipt of an application; notification of incomplete applications

A. A health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the applicant's application. The applicant shall include in the application a contact name, telephone number and e-mail address to address discrepancies in the application.

B. On receipt of an application, a health insurer shall promptly review the application to determine if the application is complete.

C. If the health insurer determines that the application is incomplete, the health insurer shall notify the applicant in writing or by electronic means that the application is incomplete within seven calendar days after the date the health insurer received the application. The notice shall include a detailed list of all of the items required to complete the application. A health insurer may request supplemental information to complete the credentialing process.

D. If the health insurer does not send the notice to the applicant within the required time frame specified in this section, the application is deemed complete for the purposes of section 20-3453.

E. If the health insurer notifies the applicant of an incomplete application in compliance with subsection C of this section, the time periods specified under section 20-3453 are tolled, and the application is suspended from the date the notification was sent to the applicant until the date on which the health insurer receives the information from the applicant to complete the application. If the health insurer has not received any response providing the requested information in subsection C of this section from the applicant after thirty calendar days, the insurer may deem the application withdrawn.

F. On receipt of a complete application, a health insurer must send the applicant a proposed contract that is complete and ready for execution by the parties.

G. A health insurer that enters into a delegated credentialing agreement with a licensed health care facility or that participates in a health insurer credentialing alliance with equivalent or higher standards than as prescribed in this section is deemed to be in compliance with the requirements of this section.