HB 4335
Relating to Medicaid providers
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to streamline the enrollment and credentialing processes for Medicaid providers in West Virginia. It establishes faster timelines for enrollment determinations and provider credentialing, particularly for managed care organizations. The bill mandates the exclusive use of electronic submissions for all credentialing applications and directs the Department of Human Services to implement a unified statewide electronic credentialing platform. Existing regulations related to uniform credentialing are repealed.
Key provisions
- Expedited enrollment timelines for Medicaid providers (5 business days for determinations).
- Uniform credentialing requirement for managed care organizations (60 calendar days for credentialing).
- Requirement for exclusive electronic submission of credentialing applications.
- Establishment of a unified statewide electronic credentialing platform.
- A one-time extension of up to 30 days for MCO credentialing requests, requiring written justification.
- Penalties for MCOs failing to meet credentialing timelines.
- Prescription of a standard credentialing form by the Office of the Insurance Commissioner.
- Restrictions on additional information required beyond the standard credentialing form.
Who is affected
- Medicaid providers
- Managed care organizations (MCOs)
- Department of Human Services
- Office of the Insurance Commissioner
- Healthcare contracting entities
Notable changes
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