P.R. Laws tit. 26, § 9325
(a) A health insurance organization or issuer shall:
(1) Establish written policies and procedures for credentialing verification of all healthcare professionals or entities with which the health insurance organization or issuer contracts and apply these standards consistently;
(2) verify the credentials of a healthcare professional or entity before entering into a contract with the same. The medical director of the health insurance organization or issuer or other designated healthcare professional shall have responsibility for, and shall participate in, healthcare professional credentialing verification;
(3) establish a credentialing verification committee consisting of licensed physicians and other healthcare professionals to review credentialing verification information and supporting documents and make decisions regarding credentialing verification;
(4) make available for review by the applying healthcare professional upon written request all application and credentialing verification policies and procedures;
(5) retain all records and documents relating to a healthcare professional's credentialing verification process for at least three (3) years, and
(6) keep confidential all information obtained in the credentialing verification process, except as otherwise provided by law.
(b) Nothing in this chapter shall be construed to require a health insurance organization or issuer to enter into contract with a provider as a participating provider solely because the provider meets the health insurance organization or issuer's credentialing verification standards, or to prevent a health insurance organization or issuer from utilizing additional criteria in selecting the healthcare professionals with whom it contracts.
History —Aug. 29, 2011, No. 194, added as § 18.050 on Aug. 23, 2012, No. 203, § 3, eff. 90 days after Aug. 23, 2012.