Credentialing – Changes Made in the 2019 Session!

January 12, 2020

DMAS published (on December 13th) a Bulletin, long awaited, that reiterates the requirements of 38.2-3407.10:1 as it was amended last Session.  The Bulletin in large part quotes the Code of Virginia, but confirms that “carriers that credential physicians or mental health professionals in its network [must] establish reasonable protocols and procedures for reimbursing new providers applicants for services provided to covered persons during the period in which the applicant’s completed credentialing application is pending.”

We have been assured by DMAS staff that this provision has been added to the MCO contracts; we have been informed by providers who have been queried that none of the MCOs have communicated any change in their practice or policy regarding credentialing.