IC 27-8-11-13.5: Provisional credentialing for physicians; conditions

Sec. 13.5. (a) As used in this section, "physician" refers to an individual who:

(1) is licensed under IC 25-22.5;

(2) has been granted reciprocity by the medical licensing board of Indiana under IC 25-1-21 before July 1, 2026; or

(3) is licensed in a state that has enacted the interstate medical licensure compact.

(b) If a physician who is fully credentialed by an insurer:

(1) leaves the employment of an employer and becomes employed with another employer in Indiana; or

(2) establishes or relocates a medical practice in Indiana;

the insurer shall provisionally credential the physician for the time frame set forth in subsection (c).

(c) A physician under subsection (b) must be provisionally credentialed:

(1) for sixty (60) days after the physician's separation from employment or the establishment or relocation of the medical practice; or

(2) until the physician is fully credentialed by the insurer;

whichever is earlier.

(d) Notwithstanding section 7(k) of this chapter, an insurer shall reimburse a physician who is provisionally credentialed under this section for services rendered while the physician was provisionally credentialed at the rates determined by:

(1) the agreement between the physician's new employer and the insurer under section 3 of this chapter; or

(2) if:

(A) the physician's new employer has not entered into an agreement with the insurer under section 3 of this chapter; or

(B) the physician established or relocated a medical practice;

the agreement between the physician and the insurer under section 3 of this chapter that was in effect at the time of the physician's separation from employment or the establishment or relocation of the medical practice.