The Hospital & Healthsystem Association of Pennsylvania

11/22/2019 | News release | Distributed by Public on 11/22/2019 16:54

Streamlined Credentialing for Physician Proposal Passes House

November 22, 2019

Yesterday, the Pennsylvania House passed House Bill 533, which will eliminate unwarranted delays by health insurers in credentialing applicants for inclusion in their network.

Under the bill, all health insurers in Pennsylvania would be required to accept the Council for Affordable Quality Healthcare's credentialing application or another nationally recognized credentialing application designated by the Pennsylvania Insurance Department in order to streamline the process. Health insurers would then have 60 days to complete the credentialing process after receiving the credentialing application.

Hospitals, physician practices, and community health centers in Pennsylvania often face the situation of newly hired health care professionals not being reimbursed by insurers for months due to insurers working through a cumbersome credentialing process. Hospitals are then burdened with absorbing the cost of these delays, with rural hospitals facing significant disadvantages, including:

  • 50 percent of Pennsylvania rural hospitals have negative operating margins
  • Patients in rural areas are often older, sicker, and poorer
  • Health professional shortages
  • Sparse population and geographical challenges create barriers

The bill passing comes on the heels of the Rural Health Redesign Bill, which recently passed the State Senate and the House and is now on its way to the Governor's desk.

HAP continues to advocate for solutions that will preserve rural health care.

For more information about Pennsylvania's rural hospitals, contact Stephanie Watkins, HAP's vice president, state legislative advocacy.