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HF 556

A bill for an act relating to health insurers’ credentialing process.

2025-2026 Regular Session Introduced by Ann Meyer

Requires insurers to respond to credentialing requests within 56 days, provide denial reasons, and offer a formal appeals route via the Insurance Division.

Withdrawn.
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Bill Summary · HF 556

Summary of HF 556 (Health Insurers’ Credentialing Process)

Note: This bill was introduced on February 24, 2025, underwent several committee actions, was renumbered as HF 875, and ultimately withdrawn on March 21, 2025. Primary sponsor: A. Meyer.

Purpose and intent

  • The bill seeks to regulate the credentialing process used by health insurers for providers who deliver care to insured individuals.
  • It aims to establish timelines, transparency, and an explicit appeals pathway to ensure providers are credentialed to provide services and to receive reimbursement under insurer-provider agreements.

Key provisions (definitions and core requirements)

  • Credentialing definition: A process by which a health insurer determines, based on criteria established by the insurer, whether a physician, advanced registered nurse practitioner (ARNP), or physician assistant (PA) is eligible to provide health care services to an insured and to receive reimbursement under an insurer–provider agreement.
  • Credentialing period definition: The time between the insurer’s receipt of a provider’s credentialing application and approval of that application.
  • Physician definition: Licensed doctor of medicine and surgery or licensed doctor of osteopathic medicine and surgery.
  • Physician assistant definition: A person licensed to practice as a PA under supervision of one or more physicians.

Core requirements and timeline

  • Response deadline: An insurer must respond to a credentialing request within 56 calendar days.
  • Denial notification: If credentialing is denied, the insurer must provide the provider with a reason for the denial.
  • Appeals process:
    • The provider may appeal the denial after an internal appeal.
    • The appeal can be filed with the Insurance Division.
    • Grounds for appeal include, in addition to other traditional grounds, network adequacy as a basis for contesting the denial.

Who/what is affected

  • Providers affected: Physicians, ARNPs, and PAs seeking credentialing with health insurers.
  • Health insurers: Responsible for credentialing determinations, timely responses, and providing explanations for denials; must manage an appeals process involving the Insurance Division.
  • Insured patients indirectly affected through the credentialing outcomes that influence access to in-network care and reimbursement.

Procedural and timeline aspects

  • Introduced 02/24/2025; referred to Health and Human Services, then rereferred to Commerce.
  • Subcommittee and committee actions occurred in late February to early March 2025, including a committee vote (Yeas 21, Nays 2) and a committee report recommending passage.
  • On 03/07/2025, the bill was renumbered as HF 875.
  • The bill was withdrawn on 03/21/2025, ending its progression in the session.

Legislative context

  • Sponsor: A. Meyer (primary).
  • The bill’s “Explanation” clarifies that it concerns the credentialing process and adds procedural safeguards for credentialing responses and appeals, including the network adequacy criterion.

Potential impact (informational)

  • Aimed to reduce credentialing delays by mandating a 56-day response window.
  • Improves transparency by requiring written reasons for denials.
  • Creates a formal appeals pathway, potentially increasing administrative review for credentialing decisions.
  • Could influence insurer operations and costs related to credentialing and appeals.
  • As of withdrawal, these provisions are not currently law. If reintroduced, they could shape credentialing practices and provider access to in-network reimbursement.

Compiled from official sources — confirm details with the bill’s official record.

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