HSB502: Health Insurer Credentialing Process

Revises the credentialing process for health insurers by replacing references to specific provider types (physicians, ARNPs, physician assistants) with the broader term "health care professional." Health insurers must now apply credentialing timelines, retrospective payment rules, and denial notification requirements to all health care professionals, as defined by Iowa law. 

Key Points & Impact:

• Replaces references to 'physician,' 'advanced registered nurse practitioner,' and 'physician assistant' with 'health care professional' throughout the section, expanding application to a wider range of provider types.

• Requires health insurers to respond within 56 days to credentialing requests from any health care professional, not just the previously listed provider types.

• Mandates that health insurers provide written reasons for denial of credentialing to any health care professional.

• Requires retrospective payment of clean claims for all health care professionals during the credentialing period, once credentialed.

• Removes specific definitions for 'advanced registered nurse practitioner,' 'physician,' and 'physician assistant' from the statute.

• Adds a cross-reference definition for 'health care professional' aligning with section 514J.102, encompassing a broad range of licensed, certified, or accredited practitioners.

• Updates definitions for 'clean claim,' 'credentialing,' and 'credentialing period' to use the broader 'health care professional' term.

• Streamlines the statutory language and reduces redundancy by consolidating provider types.