This bill mandates the Health Care Authority to create a centralized credentialing application process for Medicaid managed care providers by January 1, 2027. Under this new system, individual providers will only need to submit a credentialing application to the Health Care Authority, which will then be used by Medicaid managed care contractors to make credentialing decisions. The bill outlines specific timelines for the assessment and verification of provider qualifications, requiring contractors to respond to applications within thirty calendar days, with the possibility of a fifteen-day extension for additional considerations. Furthermore, it stipulates that contractors must load approved provider information into their payment systems within the established time frames.

Additionally, the bill specifies that once a provider is credentialed, they will not need to undergo the credentialing process again for three years. The Health Care Authority is tasked with promulgating rules to implement these provisions, while also clarifying that contractors are not obligated to credential providers who do not meet their participation requirements. Definitions for "credentialing" and "provider" are also included to ensure clarity in the application of the law.

Statutes affected:
introduced version: 27-2-12.12