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05/12/2024 04:51 PM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20210&cosponId=37346
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House Co-Sponsorship Memoranda

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House of Representatives
Session of 2021 - 2022 Regular Session

MEMORANDUM

Posted: May 18, 2022 12:25 PM
From: Representative Steven C. Mentzer
To: All House members
Subject: Insurer Credentialing Legislation (former HB 533, 2019-20)
 
Soon, I plan to introduce legislation to improve the credentialing process in Pennsylvania for health care
practitioners and address unwarranted delays by health insurers in credentialing applicants for inclusion
in their networks.

Health care practitioners routinely face delays with the credentialing process, with both commercial and
public insurers. Those who are already licensed and qualified to provide care are not reimbursed by
insurers for months while the insurers work their way through an unnecessarily long and cumbersome
credentialing process. Unwarranted delays in credentialing harms those practitioners we want to attract to
the Commonwealth the most—recent graduates who are applying for associate positions in a health care
practice and new practitioners in residency programs. Not only does this cost health care facilities
money, but it also limits access to care by keeping fully licensed and qualified providers on the sidelines
until they are credentialed by insurers. Current credentialing processes sometimes can take up to six
months or more.

My legislation would require health care practitioners and insurers to use the Council for Affordable
Quality Healthcare (CAQH) system for credentialing, limit the credentialing period to 60 days for complete
applications and streamline the process for health practitioners practicing in multiple locations.

I hope you will join in co-sponsoring this important legislation. Thank you for your interest and support.



Introduced as HB2613