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AB 1041

Health care coverage: health care provider credentials.

2025-2026 Regular Session Introduced by Dawn Addis and 1 co-sponsor

AB 1041 streamlines health care provider credentialing in California, ensuring decisions are made within 90 days, improving access and efficiency for providers and patients.

Chaptered by Secretary of State - Chapter 630, Statutes of 2025.
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Bill Summary · AB 1041

Summary of AB 1041: Health Care Coverage and Provider Credentials

Bill Number: AB 1041
Introduced: February 20, 2025
Status: Chaptered by Secretary of State - Chapter 630, Statutes of 2025
Vote: Majority
Fiscal Committee: Yes
Local Program: Yes

Purpose and Intent

AB 1041 aims to streamline the credentialing process for health care providers within California's health care service plans and health insurers. The bill establishes specific timelines and requirements for credentialing, thereby enhancing efficiency and accessibility in the health care system.

Key Provisions

  1. Credentialing Timeline:

    • Health care service plans and insurers must make a determination on a provider's credentials within 90 days of receiving a completed application, effective within one year of the bill's operative date.
    • If the 90-day requirement is not met, the provider's credentials will be provisionally approved for 120 days, unless certain disqualifying conditions apply (e.g., disciplinary actions or malpractice reports).

  2. Notification Requirements:

    • Upon receipt of a credentialing application, the health care service plan or insurer must notify the applicant within 10 business days to confirm receipt and completeness of the application.
    • Providers must be activated upon successful approval, with notification of activation sent to the applicant within 10 days of approval.

  3. Use of CAQH Credentialing Form:

    • Starting January 1, 2028, all full-service health care service plans and insurers must use the most recent version of the Council for Affordable Quality Healthcare (CAQH) credentialing form.
    • Additional information requests from providers must be minimized and should only clarify existing information on the CAQH form.

  4. Exemptions:

    • The provisions of this bill do not apply to Medi-Cal managed care plans or contracts with the State Department of Health Care Services.

  5. Criminal Penalties:

    • Willful violations of the provisions by health care service plans will be classified as a crime, establishing a state-mandated local program.

Impact

  • Health Care Providers: The bill is designed to expedite the credentialing process, allowing providers to begin offering services more quickly.
  • Health Care Plans and Insurers: These entities will need to adapt their credentialing processes to comply with the new timelines and requirements, potentially leading to increased administrative efficiency.
  • Patients: Improved access to health care providers may enhance patient care and satisfaction by reducing wait times for provider availability.

Procedural Aspects

  • The bill underwent several amendments and committee reviews before being approved by the Governor on October 11, 2025.
  • The implementation of the CAQH credentialing form is set for January 1, 2028, allowing time for health care plans and insurers to prepare for this transition.

AB 1041 represents a significant step towards improving the efficiency of health care provider credentialing in California, ultimately benefiting both providers and patients within the health care system.

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

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