The bill aims to enhance transparency and efficiency in the relationships between health carriers and healthcare providers by amending existing regulations regarding credentialing applications. It mandates that health carriers utilize a specific database for managing credentialing applications and establishes a timeline for decision-making. Effective June 1, 2020, health carriers must approve or deny credentialing applications within 90 days, with an average determination time of no more than 60 days. Additionally, starting January 1, 2027, this timeline will be further reduced to 30 days. The bill clarifies that it does not obligate health carriers to approve applications or include providers in their networks.

Furthermore, the bill introduces a new section requiring health carriers to provide comprehensive access to billing and health plan coverage information for all healthcare providers, including nonparticipating entities. This information must be easily accessible through a centralized location on the health carrier's website without requiring a login. The bill specifies that all necessary documents related to coverage, claims, and billing must be posted in a user-friendly manner, and any modifications to these documents must be communicated at least 60 days prior to their effective date.

Statutes affected:
Original bill: 48.43.750