Health care provider credentialing.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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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 extends requirements related to health care provider credentialing to include Medi-Cal managed care plans, which currently aren't subject to these rules. It mandates that these plans determine a provider’s credentials within 90 days of receiving a completed application and utilize the Council for Affordable Quality Healthcare (CAQH) credentialing form. The bill also addresses provisional approval timelines and clarifies the process for requesting additional information from providers.
Key provisions
- Extends credentialing requirements to Medi-Cal managed care plans.
- Requires plans to determine provider credentials within 90 days of receiving a complete application.
- Mandates the use of the CAQH credentialing form.
- Establishes a provisional approval timeline of 120 days under specific circumstances.
- Allows plans to request additional information from providers to clarify application details.
- Specifies a 10-business-day response time for providers to provide requested information.
- Defines a process for minimizing the number of requests for additional information.
- Requires providers to maintain credentialing information in the CAQH database.
Who is affected
- Medi-Cal managed care plans
- Health care service plans
- Health care providers
- Department of Managed Health Care
- State Department of Health Care Services
Bill text
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Sponsors
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1 on record
Primary sponsor
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