House File 875 amends Section 514F.6 of the Iowa Code to establish a clearer framework for the credentialing process of health care providers, specifically physicians, advanced registered nurse practitioners, and physician assistants. The bill introduces a new provision for retrospective payment of clean claims for covered services rendered during the credentialing period, which is defined as the time from the submission of a credentialing application to its approval. Additionally, it mandates that health insurers respond to credentialing requests within fifty-six calendar days and requires them to provide written reasons for any denial of such requests.

The bill also includes definitions for key terms such as "advanced registered nurse practitioner," "clean claim," "credentialing," "credentialing period," "physician," and "physician assistant," ensuring clarity in the application of the law. The deletion of the term "retrospective" from the previous language indicates a shift towards a more structured approach to payment processes during the credentialing period, while the new definitions aim to standardize the understanding of the roles and processes involved in health care provider credentialing.

Statutes affected:
Introduced: 514F.6
Enrolled: 514F.6