A health insurance organization or issuer shall provide a healthcare professional or entity the opportunity to review and correct information submitted in support of his/her credentialing verification application as set forth below.\n(a) Each healthcare professional or entity that is subject to the credentialing verification process shall have the right to review all information, including the source of that information, obtained by the health insurance organization or issuer during the credentialing process.\n(b) A health insurance organization or issuer shall notify a healthcare professional of any information obtained that does not meet its credentialing verification standards or that varies substantially from the information provided by the healthcare professional or entity. Notwithstanding the foregoing, the health insurance organization or issuer shall not be required to reveal the source of information, if such disclosure is prohibited by law.\n(c) A healthcare professional or entity shall have the right to correct any erroneous information. A health insurance organization or issuer shall have a formal process whereby a healthcare professional or entity may submit ional or entity shall have the right to correct any erroneous information. A health insurance organization or issuer shall have a formal process whereby a healthcare professional or entity may submit supplemental or corrected information to the credentialing verification committee and request reconsideration, if the healthcare professional or entity believes that the committee has received information that is incorrect, misleading or erroneous. Supplemental information shall be subject to confirmation by the health insurance organization or issuer.\nHistory —Aug. 29, 2011, No. 194, added as § 18.070 on Aug. 23, 2012, No. 203, § 3, eff. 90 days after Aug. 23, 2012.
Puerto Rico Legal Code