The Hospital & Healthsystem Association of Pennsylvania

09/18/2019 | News release | Distributed by Public on 09/18/2019 16:13

Legislation Improving Credentialing Process for Health Care Practitioners Passes Committee

The Pennsylvania House Health Committee today unanimously approved HAP-supported legislation that streamlines and improves the insurer credentialing process for health care practitioners.

House Bill 533, sponsored by Representative Clint Owlet (R-Tioga), addresses unwarranted delays by health insurers in credentialing applicants for inclusion in their networks. The bill would require health insurers to standardize the credentialing application and to issue a credentialing determination within 45 days after receiving a completed credentialing application. It also would impose administrative penalties for insurers if they fail to use the designated applications or complete the credentialing process as required.

Especially in areas experiencing provider shortages, these delays can prevent new or relocating physicians from beginning practice and being reimbursed for seeing patients, and contribute to higher costs due to unnecessary administrative burdens. For example, one hospital serving a rural community requires two dedicated full-time staff to manage the credentialing process. While waiting for plan approval, the hospital's affiliated practices reportedly lose $400,000 to $480,000 solely due to credentialing process delays. Other hospitals reported that, in some cases, credentialing delays translate into clinicians providing care for which their hospitals will never be reimbursed.

House Bill 533 mirrors legislation that unanimously passed the House unanimously last session. Health care advocacy groups including the Pennsylvania Academy of Family Physicians, the Pennsylvania Medical Society, the Pennsylvania Association of Community Health Centers, the Pennsylvania Osteopathic Medical Association, and the Coalition of Nurse Practitioners also support the bill.

HAP thanks Representative Owlett for his leadership on House Bill 533. Representative Owlet and Chair of the Committee, Representative Kathy Rapp (R-Warren), spoke to the impact that the current credentialing process has on rural hospitals' ability to attract and retain providers amidst a growing shortage, as well as on the cost to the health care system. The reforms included in House Bill 533 are critical to resolving this fixable administrative barrier and bringing much needed resources and increasing access to care to those who need it most.

For additional information, contact Stephanie Watkins, HAP's vice president, state legislative advocacy.