A health insurance organization or issuer shall:\n(a) Obtain primary verification of at least the following information about the applicant:\n(1) Current license, certificate of authority or registration to practice his/her profession in Puerto Rico;\n(2) meets financial responsibility requirements;\n(3) status of hospital privileges (if applicable);\n(4) specialty board certification status (if applicable);\n(5) current Drug Enforcement Agency (DEA) registration certificate (if applicable);\n(6) graduation from an accredited professional school, and\n(7) completion of post graduate training (if applicable).\n(b) Obtain, subject to either primary or secondary verification at the health insurance organization or issuer's discretion:\n(1) The healthcare professional's license history in Puerto Rico and all other states;\n(2) the healthcare professional's malpractice history, and\n(3) the healthcare professional's practice history.\n(c) At least every three (3) years, obtain primary verification of a participating healthcare professional's:\n(1) Current license, certificate of authority or registration to practice his/her profession in Puerto Rico;\n(2) meets financial responsibility ication of a participating healthcare professional's:\n(1) Current license, certificate of authority or registration to practice his/her profession in Puerto Rico;\n(2) meets financial responsibility requirements;\n(3) status of hospital privileges (if applicable);\n(4) current DEA registration certificate (if applicable), and\n(5) specialty board certification status (if applicable).\n(d) Require all participating providers to notify the health insurance organization or issuer of changes in the status of any of the items listed in this section and indicate to the participating providers the contact information to report such changes.\nHistory —Aug. 29, 2011, No. 194, added as § 18.060 on Aug. 23, 2012, No. 203, § 3, eff. 90 days after Aug. 23, 2012.
Puerto Rico Legal Code