Bill > AB1041

This bill requires health care service plans and health insurers to streamline and expedite their provider credentialing process by mandating several key changes. Starting January 1, 2028, all full-service health care plans and insurers must use the Council for Affordable Quality Healthcare (CAQH) credentialing form and follow its processes, which aims to standardize and simplify provider registration. Within one year of the bill's operative date, these organizations must make a credentialing determination within 90 days of receiving a complete application, notify the applicant within 10 business days of receiving the application, and activate the provider upon successful approval. If the 90-day requirement is not met, the provider's credentials will be provisionally approved for 120 days, unless specific exceptions apply, such as pending disciplinary actions or adverse reports in the National Practitioner Data Bank. The bill limits additional information requests from providers, requiring clarification only for information not fully disclosed in the initial CAQH form, and mandates that providers respond within 10 business days. Notably, Medi-Cal managed care plans are excluded from these requirements. The bill also includes a provision that no reimbursement is required for implementing these changes, as they potentially create or modify criminal infractions.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB1041