Bill > SB888

This bill establishes new rules for health care practitioner credentialing in Pennsylvania, focusing on standardizing and streamlining the process for health insurers. The bill requires all health insurers to accept the CAQH (Council for Affordable Quality Healthcare) credentialing application, a standardized electronic form used to collect professional credentials data. Health care practitioners, including doctors, dentists, and those working in federally qualified health centers, must use this application when seeking to join an insurer's provider network. The bill mandates that insurers respond to credentialing applications within specific timeframes: they must notify applicants within 10 business days about the completeness of an application and issue a credentialing determination within 45 business days. If a practitioner's application is approved for multiple locations, they will be automatically credentialed across those locations. The Insurance Department is empowered to assess administrative penalties on health insurers who fail to follow these guidelines, though insurers cannot be penalized for an applicant's incomplete application. Importantly, the bill does not guarantee that a health care practitioner will be accepted into any specific insurance network. The new regulations will take effect 180 days after the bill's passage, allowing time for insurers and practitioners to adjust to the new standardized credentialing process.

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https://www.legis.state.pa.us/cfdocs/billinfo/bill_history.cfm?syear=2025&sind=0&body=S&type=B&bn=888