The proposed bill would update the current health insurance provider credentialing process by reducing the timeframe for insurers to complete credentialing from 100 days to 60 calendar days and requiring them to load applicant information into the billing system within 30 days. It mandates that insurers acknowledge receipt of applications within seven days and provide detailed notices for incomplete applications. Additionally, the bill limits the tolling of application processing time to three instances and allows insurers to consider applications withdrawn if further information is not provided within a specified timeframe. Moreover, the bill introduces new provisions for claims processing, requiring insurers to process claims as in-network claims for services rendered by providers who have applied for credentialing and are eligible members on the date of service. It prohibits insurers from denying claims submitted within one year after the date of service based on timing issues, provided they meet statutory requirements. The bill removes the definition of "credentialing" and modifies the definition of "participating provider" to include those contracted to provide services to subscribers, aiming to enhance the efficiency of the credentialing process and improve transparency for both 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