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State House Health Committee Passes Bill to Streamline Physician Credentialing

April 04, 2017

After debate as well as questions from members of the committee, Pennsylvania’s House Health Committee voted to advance House Bill 125, the Health Care Practitioner Credentialing Act. The HAP-supported legislation would establish a streamlined process for insurance credentialing for health care practitioners.

The bill, sponsored by Committee Chair Rep. Matt Baker (R-Bradford), would require all insurers to accept the Council for Affordable Quality Healthcare’s (CAQH) credentialing application for initial credentialing and re-credentialing and render a decision within 30 days. If the insurer would fail to issue a decision on an application within 30 days, the provider would be considered provisionally credentialed and receive reimbursement for services rendered under the same terms as that provider’s practice group.

This legislation also would help to improve patients’ access to care and providers’ efficiencies by addressing:

  • Unnecessary delays in the credentialing process
  • Limited patient access and delays in care because insurance will not cover care with providers until credentialing is completed (a patient could wait an extra three to six months until a physician has been credentialed at their local hospital or community health center)
  • Payment by hospitals, physician practices, and health clinics of employed but “side-lined” physicians who are waiting to be credentialed so that they can see patients

The proposed reforms would minimize current administrative burdens, expedite the credentialing process, and sustain the ability of insurers to make sure that providers within their networks are appropriately licensed and qualified.

Under the current credentialing process, newly hired health care professionals who are fully licensed and qualified to practice and see patients are not reimbursed during the insurers’ credentialing process. This process could take months, unnecessarily causing access issues for patients and costing facilities financially.

HAP is joined by the Pennsylvania Medical Society and the Pennsylvania Academy of Family Physicians in strongly supporting this legislation. HAP applauds the efforts of Chairman Matt Baker and the members of the committee.

This issue was voted out of committee at the end of the last legislative session. House Bill 1663 ran out of session days to be considered by the full House.

For additional information about the importance of more streamlined physician credentialing, read “Pennsylvania’s Physician Credentialing Process Is Keeping Doctors from Patients,” by HAP’s Michael J. Consuelos, MD, senior vice president, clinical integration.

For more information about House Bill 125, contact HAP’s Stephanie Watkins, vice president, state legislative advocacy.

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