The bill HB2035 introduces significant changes to the procedures surrounding health care claim denials, dispute resolution, and provider credentialing. It requires health care insurers to provide contact information for inquiries at the time of claim denial, respond to grievances within set timeframes, and furnish detailed explanations of denials along with the rights of providers. A notable change is the reduction of the credentialing process timeline from 100 days to 45 days, and insurers are mandated to pay claims retroactively to the date of a provider's complete credentialing application if the provider had a valid contract when services were rendered.

Additionally, the bill eliminates the ability of insurers' designees to credential providers, ensuring that only insurers handle this process. It establishes a structured appeal process for providers, including the right to request a hearing with the Department of Insurance and Financial Institutions (DIFI) for unresolved disputes. Overall, HB2035 aims to enhance transparency, accountability, and efficiency in health insurance claims and credentialing, ultimately supporting health care providers in their dealings with insurers.

Statutes affected:
Introduced Version: 20-3101, 20-3102, 20-3103, 20-3104, 20-3451, 20-3453, 20-3456, 20-1137, 20-2533, 12-908, 20-3321
House Engrossed Version: 20-3101, 20-3102, 20-3103, 20-3104, 20-3451, 20-3453, 20-3456, 20-1137, 20-2533, 12-908, 20-3321