HB 3242
Requires health insurers to pay providers who are joining an in-network practice the same as in-network providers during the credentialing period.
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Sign in to take actionPublic sentiment
Support
100%
Oppose
0%
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill requires Oregon health insurers to pay doctors and other healthcare providers the same rates as in-network providers during the time they are applying to join an insurer’s network. It also establishes a process for insurers to notify providers if their credentialing applications are incomplete and outlines repayment rules if a provider doesn’t meet credentialing requirements. The bill aims to ensure fair compensation for providers during the often lengthy credentialing process.
Key provisions
- Health insurers must pay joining providers at the same rate as in-network providers during the credentialing period.
- Insurers must notify providers if their credentialing applications are incomplete.
- Providers who don't meet credentialing criteria or submit complete applications may be required to repay the insurer.
- Insurers can pay claims for services provided during the credentialing period at the rate for non-participating providers.
- A provider can submit claims within six months of the credentialing period's end without facing denial for timely submission.
- Certain rejections or terminations of providers due to substandard care are excluded from this requirement.
- The credentialing period is defined as 90 days from application receipt or approval/rejection.
- The bill applies to health insurers offering managed or preferred provider organization insurance, excluding HMOs.
Who is affected
- Health insurers
- Healthcare providers
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
E. Werner Reschke
Arguments in favor
Reasons to support this legislation.
Supporters of House Bill 3242A and 3242 agree that the legislation is crucial in addressing the existing shortage of medical providers and reducing wait times for patients. They argue that by requiring health insurers to pay in-network providers during the credentialing period at the same rate as in-network providers, significant benefits will be provided to new providers, ensuring they see patients sooner. The Oregon Medical Association and other supporters emphasize the importance of fair compensation for clinicians joining an in-network practice, promoting continuity of patient care and reducing administrative burden on healthcare practices and clinics. By facilitating timely access to care, these provisions aim to address the pressing need for more medical providers in the state.
Source: Testimony Summaries
Arguments opposed
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