Bill > HB544

This bill establishes the Health Care Practitioner Credentialing Act, which standardizes and streamlines the credentialing process for health care practitioners seeking to join health insurers' provider networks in Pennsylvania. The bill requires all health insurers to accept the CAQH (Council for Affordable Quality Healthcare) credentialing application or another nationally recognized form when health care practitioners apply to join their networks. Health insurers must notify practitioners within 10 business days of receiving an application whether it is complete, and must make a credentialing determination within 45 business days. If a practitioner's application is approved and they work in multiple locations, they will be automatically credentialed for all those locations. The Insurance Department is empowered to assess administrative penalties against health insurers that fail to follow these procedures, though insurers cannot be penalized for issues caused by practitioners' incomplete applications. Importantly, the bill does not guarantee that any health care practitioner will be accepted into a network, merely that the application process will be more standardized and transparent. The act will take effect 180 days after its passage, giving health insurers time to adapt to the new requirements.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=H&type=B&bn=544