The Health Care Practitioner Credentialing Act establishes requirements for health insurers in Pennsylvania regarding the credentialing process for health care practitioners. Under this act, all licensed health insurers must accept the CAQH credentialing application or another nationally recognized form designated by the Insurance Department when submitted by health care practitioners seeking participation in their provider panels. The act mandates that health insurers notify practitioners within 10 business days of receiving an application about its completeness and issue a credentialing determination within 45 business days if the application is complete. Additionally, if a practitioner is credentialed for multiple locations, they will be automatically credentialed for all those locations.

The act also imposes penalties on health insurers that fail to utilize the CAQH application or do not complete the credentialing process as required. However, it clarifies that health care practitioners do not have guaranteed rights to participate in any health insurer network, nor are insurers required to accept all willing providers. The Insurance Department is tasked with creating rules and regulations to enforce the act, which will take effect 180 days after its passage.