The bill amends Section 514F.6 of the Iowa Code to enhance the credentialing process for health insurers. It introduces a requirement for health insurers to respond to credentialing requests from physicians, advanced registered nurse practitioners, or physician assistants within fifty-six calendar days. If a request is denied, the insurer must provide a written explanation for the denial. Additionally, the bill allows for an internal appeal process, after which the applicant can appeal to the insurance division, with network adequacy being a valid ground for such an appeal.

The bill also establishes a new provision for retrospective payment of clean claims for covered services provided during the credentialing period, once the healthcare provider is credentialed. Definitions for key terms such as "advanced registered nurse practitioner," "clean claim," "credentialing," "credentialing period," "physician," and "physician assistant" are included to clarify the scope of the legislation. Overall, the bill aims to streamline the credentialing process and ensure transparency and fairness in the handling of credentialing requests by health insurers.

Statutes affected:
Introduced: 514F.6