Health insurers; provisional provider credentialing
This bill will affect the credentialing process for providers starting from December 31, 2026, thereby offering a significant advance in the regulatory landscape governing healthcare provision in Arizona.
During the provisional credentialing period, the bill requires health insurers to pay all claims submitted by the provider at contractual rates established with the affiliated group practice or healthcare institution. This approach aims to enhance access to healthcare for patients by allowing newly credentialed providers to begin offering services without delay while ensuring insurers promptly process claims.
SB1228, introduced by Senator Fernandez, amends Title 20, Chapter 27, Article 1 of the Arizona Revised Statutes by adding a new section 20-3460 that establishes a framework for provisional credentialing of healthcare providers by health insurers. The bill mandates that a health insurer must grant provisional credentialing to a provider upon receiving a complete credentialing application, provided the provider is licensed in Arizona, is in good standing, and has previously been credentialed by a licensed healthcare institution or credentialing verification organization.
The bill establishes that provisional credentialing remains in effect until the insurance company has either approved or denied the application or until sixty days have passed following the application submission. In cases of denial, insurers are not obligated to reimburse claims for services rendered after the denial date. Critics of the bill may express concern about the potential financial implications for health insurers and the management of the claims process during the provisional period, highlighting a need for balance between expedited access to care and insurer risk mitigation. The legislation may be regarded as a necessary modernization in response to evolving healthcare delivery models.