The proposed bill would update the current statutes governing 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 a detailed list of any incomplete items. If an application is incomplete, insurers must inform the applicant within the same seven calendar days and are limited to tolling the processing time no more than three times. Additionally, the bill would introduce new requirements for claims processing, allowing claims from providers who have applied for credentialing to be treated as in-network claims under certain conditions. It would also prohibit insurers from denying claims submitted within one year after the date of service based on timing issues, while clarifying that reimbursement at in-network rates is not required if the credentialing application is not approved. The bill would repeal existing language related to credentialing and emphasize transparency by requiring providers to disclose their credentialing status and estimated costs to patients before services are rendered. Overall, these updates aim to streamline the credentialing process and improve communication among health insurers, 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