The proposed bill would update current statutes related to the health insurance provider credentialing process by introducing specific timelines and requirements for health insurers. Under the new provisions, insurers would be mandated to complete the credentialing process within 60 calendar days and input the applicant's information into their billing system within 30 days of receiving a complete application. Insurers would also need to acknowledge receipt of applications within seven calendar days and provide detailed notices for any incomplete applications. The bill limits the ability of insurers to toll the processing time to no more than three times and requires communication of any application withdrawals within seven calendar days. Additionally, the bill modifies the definition of a complete credentialing application to include necessary documentation and authorization for processing, while removing the previous definition of credentialing. It also updates the definition of participating provider to include contracted providers. New provisions would allow providers to receive payment for services rendered during the credentialing process, with claims submitted within one year after the date of service being protected from denial based on timing if they meet the new requirements. Overall, these changes aim to streamline the credentialing process and improve transparency and efficiency for health care providers and patients.

Statutes affected:
Introduced Version: 20-3451, 20-3453, 20-3456, 20-3321
Senate Engrossed Version: 20-3451, 20-3453, 20-3454, 20-3456, 20-3459, 20-3321
House Engrossed Version: 20-3451, 20-3453, 20-3454, 20-3456, 20-3459, 20-3321
Chaptered Version: 20-3451, 20-3453, 20-3454, 20-3456, 20-3459, 20-3321