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Bill to Reform Insurer Credentialing Process Passes Pa. House in Unanimous Vote

A bill which seeks to reform the process of insurer credentialing for health care practitioners was passed unanimously by the Pa. House on May 24, 2017. HB 125, introduced by Rep. Matt Baker (R-68th District), now moves on to the Pa. Senate for consideration.

Noteworthy provisions in the latest version of the bill include the following:

  • Requires all insurers licensed to do business in Pennsylvania to accept the Council for Affordable Quality Healthcare (CAQH) application or other form designated by the Pennsylvania Insurance Department so long as the form is nationally recognized as an appropriate credentialing application when submitted by a health care practitioner for participation in the health insurer's provider panel.
  • An application shall be considered complete if the application is submitted through the CAQH electronic process and all required information is provided.
  • The health insurer shall issue a credentialing determination within 45 days after receiving a complete CAQH credentialing application.

The issue of insurer credentialing for physicians is one of the Pennsylvania Medical Society's (PAMED) advocacy priorities this year. While work now shifts to the Senate in the hopes that they will complete the process, this positive outcome is the result of great work by the PAMED government relations staff working for countless hours with both the legislature and other stakeholders to get to this important milestone.

Currently, there is not a uniform credentialing process in Pennsylvania. This means a physician may have to navigate different processes to get credentialed by each insurer, thus causing a physician to spend time on credentialing rather than on patient care. 

PAMED supports a quicker, more streamlined credentialing process. Now that HB 125 has passed the House, PAMED will be focusing our advocacy efforts on the Senate. We will share any updates on HB 125 via the Dose email newsletter, our website at www.pamedsoc.org, and our mobile app.

Find out more about some of PAMED's other advocacy priorities – including prior authorization reform and the support of physician-led, team-based care – online at www.pamedsoc.org/advocacy.

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