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House of Representatives
Session of 2017 - 2018 Regular Session


Posted: December 7, 2016 02:18 PM
From: Representative Matthew E. Baker
To: All House members
Subject: Insurer Credentialing Legislation

In the near future, I plan to reintroduce 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.

Hospitals, physician practices and community health centers routinely face the situation where a newly hired health care professional who is fully licensed and qualified to provide care is not reimbursed by insurers for months while the insurers work their way through an unnecessarily long and cumbersome credentialing process. Not only does this cost these 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.

My legislation creates a freestanding act to provide for the use of a certain credentialing application that health care providers will be required to use when seeking to become credentialed by a health insurer. Additionally, provisional credentialing will be granted to eligible applicants if a health insurer fails to issue a credentialing determination within 30 days after receiving the completed form.

This legislation has the support of the Pennsylvania Medical Society, the Hospital and Healthsystem Association of PA, the Coalition of Nurse Practitioners, the PA Academy of Family Physicians and the PA Association of Community Health Centers.

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

Introduced as HB125