Health care coverage: health care provider credentials.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Chaptered
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill requires health care service plans and health insurers to use a standardized credentialing form provided by the Council for Affordable Quality Healthcare (CAQH) starting January 1, 2028. It also mandates that these plans or insurers make a determination regarding a provider’s credentials within 90 days of receiving a completed application, with provisional approval for up to 120 days if the 90-day deadline isn’t met. The bill excludes Medi-Cal managed care plans from these requirements and includes provisions regarding additional information requests and maintaining credentialing data in the CAQH database.
Key provisions
- Requires health plans and insurers to use the CAQH credentialing form.
- Sets a 90-day deadline for credentialing determinations.
- Allows for 120-day provisional approval if the 90-day deadline isn't met.
- Specifies procedures for requesting additional information from providers.
- Requires providers to maintain credentialing information in the CAQH database.
- Excludes Medi-Cal managed care plans from the requirements.
- Defines circumstances under which provisional approval may be granted.
- Establishes a timeline for compliance with the new credentialing requirements.
Who is affected
- Health care service plans
- Health insurers
- Health care providers
- Patients
- Insurance companies
Notable changes
Bill text
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