Bill > HF556

This bill modifies the existing law regarding health insurers' credentialing process for physicians, advanced registered nurse practitioners, and physician assistants. The bill requires health insurers to respond to credentialing requests within 56 calendar days and mandates that if a credentialing request is denied, the insurer must provide a written explanation for the denial. The legislation also establishes an appeals process, allowing healthcare providers to appeal a denial through an internal appeal and then to the insurance division, with network adequacy specifically recognized as a valid grounds for appeal. Additionally, the bill provides clear definitions for key terms such as "credentialing" (the process by which an insurer determines a healthcare provider's eligibility to provide services and receive reimbursement), "clean claim" (referencing an existing definition in state law), and specifies the types of healthcare professionals covered (including doctors of medicine and surgery, doctors of osteopathic medicine and surgery, advanced registered nurse practitioners, and physician assistants). The bill also maintains the existing requirement for retrospective payment of clean claims during the credentialing period once a provider is ultimately credentialed.

Business and Industry, Health and Social Services

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF556