Section 26-A4299. DEFINITIONS


Latest version.
  • 4299.1When used in this chapter, the following terms and phrases shall have the meanings ascribed:

    “Act” means the Health Insurers and Credentialing Intermediaries Uniform Credentialing Form Act of 2002 (D.C. Law 14-96; D.C. Official Code § 31-3251 et seq.(Supp. 2002).

    “Commissioner” means Commissioner of the District of Columbia Department of Insurance, Securities, and Banking.

    “Credentialing Intermediary” means a person to whom a health insurer has delegated credentialing or re-credentialing authority and responsibility.

    “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, including an insurer, a hospital and medical services corporation, a fraternal benefit society, or any other person providing a plan of health insurance subject to the authority of the Commissioner.

    “Provider application” means the uniform credentialing form that the Commissioner of this department adopted to comply with the Health Insurers and Credentialing Intermediaries Uniform Credentialing Form statute.

    “Provider panel” means providers that contract with a health insurer to provide health care services to the enrollees under a health benefit plan of the health insurer.

    “Uniform credentialing form” means the form designed by the Commissioner through regulation for use by a health insurer or its credentialing intermediary for credentialing and re-credentialing of a health care provider for participation on a provider panel.

    “§44-501 entity” means an agency, organization, facility, or distinct part of any of them, licensed under D.C. Official Code § 44-501 et seq. (2001).

authority

The Commissioner of the Department of Insurance, Securities and Banking (“Commissioner”), pursuant to the authority set forth in § 104 of the Health Insurers and Credentialing Intermediaries Uniform Credentialing Form Amendment Act of 2001, effective April 13, 2002 (D.C. Law 14-96; D.C. Official Code § 31-3254 (2005 Supp.)).

source

Notice of Final Rulemaking published at 53 DCR 6531, 6532 (August 11, 2006).