An Inefficient Insurer Credentialing Process Delays Patient Care – This Pa. Bill Offers a Solution

Last Updated: Sep 26, 2019

credentialingThe insurer credentialing process is a perennial source of frustration for Pennsylvania physicians. Some doctors are forced to wait months for a credentialing determination.

Every insurance provider has its own set of requirements. Keeping track of them all creates administrative burdens for practices and health systems.

And, the often-slow credentialing process can delay patient care.

Credentialing Bill on the Move in Harrisburg

Legislation to address these credentialing hassles – House Bill 533 – was introduced by Rep. Clint Owlett earlier this year. The Pennsylvania Medical Society (PAMED) supports the bill.

With lawmakers back at the Capitol for the fall session, the credentialing bill is on the move. On Sept. 18, 2019, HB 533 was approved by the House Health Committee, and it now awaits consideration by the full House.

The bill aims to bring uniformity to the credentialing process by:

  • Requiring health insurers to accept the Council for Affordable Quality Healthcare (CAQH) credentialing application or other nationally recognized form designated by the Pennsylvania Insurance Department.
  • Setting a time limit for health insurers to issue a credentialing determination after receiving a completed credentialing application – The language of the bill as currently written would require a determination to be issued within 45 days.
  • Enabling the Insurance Department to assess penalties on health insurers for failure to use the required application or for intentionally and routinely failing to complete the required process.

HB 533 would not guarantee the rights of a health care practitioner to participate in any health insurer network nor would it require a health insurer to accept any willing health care provider to its network.

PAMED Advocacy & Next Steps

PAMED is involved in ongoing discussions with legislators on the issue of credentialing, sharing the frustrations our members have with the current process.

We will share any updates on the bill with our members.

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