This bill amends the Michigan Insurance Code of 1956 by adding a new section, 3406mm, which establishes specific requirements for insurers regarding the credentialing of health care providers. Insurers must assess and verify the qualifications of a provider within 60 calendar days of receiving a complete application and notify the applicant of their decision in writing. If the application is incomplete, insurers are required to inform the applicant within 10 business days, detailing what additional information is needed. The bill also allows insurers to extend the credentialing period by an additional 15 days if certain circumstances warrant further review.

Additionally, the bill mandates that health care providers whose applications are pending for more than 60 calendar days must be reimbursed for covered services, provided they meet specific criteria, including having submitted a complete application and not having any license sanctions. The reimbursement rates for these providers are defined based on whether they are part of a contracted group or practice. The bill aims to streamline the credentialing process and ensure timely reimbursement for health care providers, thereby enhancing access to care for patients.

Statutes affected:
Senate Introduced Bill: 500.100, 500.8302