The bill amends the Nonprofit Health Care Corporation Reform Act by adding Section 414c, which establishes new requirements for health care corporations regarding the credentialing process for health care providers. Under this section, health care corporations must assess and verify the qualifications of providers within specified time frames after receiving a complete credentialing application. They are required to notify applicants of any missing information within 10 business days and must load approved provider information into their payment systems within 60 calendar days, with the possibility of extending this period under certain circumstances.

Additionally, the bill mandates that health care corporations reimburse providers for covered services if their credentialing applications are not approved or denied within the established time frames, provided the providers meet specific criteria. The reimbursement rates are defined based on whether the provider is part of a contracted practice or group, and the bill clarifies the definition of "health care provider" to include various licensed professionals such as physicians, psychologists, and social workers. Overall, the bill aims to streamline the credentialing process and ensure timely reimbursement for health care providers.

Statutes affected:
Senate Introduced Bill: 550.1101, 550.1704