qualifications of a health care practitioner, including, but not
limited to, an evaluation of licensure status, education,
training, experience, competence and professional judgment.
"Enrollee." Any policyholder, subscriber, covered person,
covered dependent, spouse or other person who is entitled to
receive health care benefits from a health insurer.
"Health care practitioner." As defined under section 103 of
the act of July 19, 1979 (P.L.130, No.48), known as the Health
Care Facilities Act.
"Health insurer." An entity that contracts or offers to
contract to provide, deliver, arrange for, pay for or reimburse
any of the costs of health care services in exchange for a
premium, including, but not limited to, a Medicaid managed care
organization as defined under the act of June 13, 1967 (P.L.31,
No.21), known as the Public Welfare Code, and an entity licensed
under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
Section 3. Utilization of CAQH.
All health insurers licensed to do business in this
Commonwealth shall be required to accept the CAQH credentialing
application when submitted by a health care practitioner for
participation in the health insurer's provider panel. An
application shall be considered complete if the application is
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