SB1154: Health insurance; online credentialing system, processing of new applications.

Legislative Summary

Health insurance; provider credentialing; processing of new applications. Requires a health insurance carrier that credentials the physicians, mental health professionals, or other providers in its network to establish reasonable protocols and procedures for processing of new provider credentialing applications. The bill requires that if the carrier accepts applications through an online credentialing system, the carrier must notify a new provider applicant through the online credentialing system that the application is received. If the carrier does not accept applications through an online credentialing system, the bill requires the carrier to provide, within 10 days of receiving an application, notification to the new provider applicant that the application was received. The bill provides that, beginning January 1, 2024, a new provider applicant's application will be deemed complete within 30 days of the carrier receiving the application, unless the carrier has provided notice that the application is not complete. Under the bill, a carrier must approve or deny new provider applicant credentialing applications within 60 days of receiving a completed application and claims submitted according to carrier claims submittal policies must be adjudicated and paid no later than 40 days after the new provider applicant is credentialed and contracted. The bill directs the Virginia Department of Health to adopt emergency regulations to implement the provisions of the bill.