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HB 8310

AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- HEALTHCARE PROVIDER CREDENTIALING

2026 Regular Session Introduced by Megan Cotter and 9 co-sponsors

Rhode Island lowers credentialing decisions to 30 days, requires complete-application standards, auto status updates, and retroactive payback plus provisional credentials if timeli

04/14/2026 Committee recommended measure be held for further study
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Bill Summary · HB 8310

Bill Summary: HB 8310 (Rhode Island, 2026)

Title

AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES -- HEALTHCARE PROVIDER CREDENTIALING

Purpose and Intent

  • The bill amends Rhode Island statute to modify the timeline and procedures for healthcare provider credentialing by health plans and healthcare entities.
  • It aims to reduce delays in credentialing decisions, improve transparency and communication with applicants, and establish accountability for credentialing timelines.
  • The changes apply to multiple chapters governing various health arrangements (Insurance "Accident and Sickness Policies," Nonprofit Hospital Service Corporations, Nonprofit Medical Service Corporations, and Health Maintenance Organisations).

Key Provisions

General Credentialing Timelines (for applications received on/after Jan 1, 2018)

  • Requirement: Health plans/entities must issue a decision on credentialing as soon as practicable, but no later than:
    • 30 calendar days after receipt of a complete credentialing application (formerly 45 days).
    • For providers already credentialed with Medicare, 10 business days.
  • Minor demographic changes:
    • Must be completed within 5 business days (revised from 7 days) of receipt.
    • Applies to changes such as address or Tax Identification Number.

Completeness and Status

  • Each entity/plan must publish a written standard for what constitutes a complete credentialing application; the standard must accompany the credentialing application and be accessible on the website.
  • If the payer fails to meet the credentialing timeline, the provider is deemed provisionally credentialed.
  • The payer must retroactively reimburse the provider for all covered services from the date the completed application was received.

Inquiries and Notifications

  • Providers may obtain status updates automatically:
    • Automated updates at least every 15 calendar days regarding missing materials until complete.
  • Notification of completion:
    • The entity/plan must inform the applicant within 5 business days that the credentialing application is complete.
  • Denials:
    • If credentialing is denied, the entity/plan must provide written notice detailing all reasons.

Billing Privileges

  • The effective date for billing privileges is the next business day after credentialing approval.

Resident Graduates (Transitional/Conditional Approval)

  • For applications from resident graduates received on/after Jan 1, 2018, entities/plans must offer transitional or conditional approval:
    • Conditional approval may be granted, effective upon successful graduation, if the applicant has submitted a complete application and met all other criteria.

Definitions (Section-wide)

  • Complete credentialing application: all requested material submitted.
  • Date of receipt: date the completed application is received, whether electronically or on paper.
  • Healthcare entity: licensed insurer, nonprofit hospital/medical/dental service organization, or plan that operates a health plan.
  • Health plan: plan operated by a healthcare entity that delivers services to enrolled persons, including provider arrangements and financial incentives for use of participating providers.

Enforcement and Oversight

  • The Rhode Island Office of the Health Insurance Commissioner may:
    • Enforce the provisions and impose administrative penalties as authorized.
    • Promulgate regulations to implement the chapter.
    • Require payers to submit quarterly reports on credentialing timelines.
  • Non-compliant contract provisions are void.

Affected Entities and Persons

  • Healthcare entities and health plans operating in Rhode Island (including insurers, nonprofit hospital service corporations, nonprofit medical service corporations, health maintenance organizations, and related contractors that operate health plans).
  • Healthcare providers seeking credentialing (physicians, nurses, and other health professionals).
  • Resident graduates entering practice in Rhode Island health plans (via transitional/conditional approvals).

Effective Date

  • The act takes effect upon passage.

Summary of What It Changes

  • Lowers the credentialing decision deadline from 45 days to 30 days (30-day target; 10 business days if Medicare credentialed).
  • Accelerates minor demographic change processing to 5 business days.
  • Establishes explicit standards for what constitutes a complete application and requires publication of those standards.
  • Improves applicant communication with automatic status updates every 15 days and a formal 5-day completion notice.
  • Requires retroactive reimbursement if timelines are not met.
  • Introduces provisional credentialing when timelines are missed.
  • Requires transitional/conditional approval for certain resident graduates.
  • Enhances enforcement and quarterly reporting obligations for payers.

Why It Matters

  • Aims to reduce administrative delays in credentialing, enabling providers to bill for services sooner and reducing potential access-to-care issues for patients.
  • Increases transparency and accountability in the credentialing process.
  • Provides protections for providers through provisional credentialing and retroactive reimbursement when delays occur.

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

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