The proposed bill would amend several sections of the Arizona Revised Statutes related to provider credentialing. Key updates include the introduction of a definition for "Complete credentialing application," which specifies that it encompasses the submission of a health plan's credentialing application along with supporting documents. Additionally, the bill modifies the definitions of "Credentialing," "Designee," and "Health insurer," removing references to "its designee" in the context of credentialing and recredentialing processes. The term "Recredential" is also updated to clarify that it involves confirming a provider's good standing without requiring a new application or contracting process.

Furthermore, the bill establishes new timelines for health insurers regarding the credentialing process. It mandates that insurers must conclude the credentialing and loading process within 145 calendar days of receiving a complete credentialing application. It also requires health insurers to provide written or electronic confirmation of receipt of applications within two business days and to notify applicants of any deficiencies within seven business days. Importantly, the bill stipulates that health insurers must retroactively approve a participating provider's credentialing application to the date of the complete application, ensuring that claims for covered services provided by credentialed providers are paid accordingly.

Statutes affected:
Introduced Version: 20-3451, 20-3453, 20-3456, 20-3321