HB0082

Establishes credentialing standards and timelines for health care providers applying to participate in health insurance carrier networks.

• Defines key terms including applicant, credentialing, completed credentialing application, and health carrier for purposes of the chapter. (W.S. 26-56-101)
• Requires health carriers to notify applicants within seven calendar days of receiving a credentialing application and provide contact information for the reviewer. (W.S. 26-56-102(a))
• Requires health carriers to notify applicants within thirty calendar days if an application is incomplete, specifying what is needed for completion. Applicants have thirty calendar days to submit a completed application; failure to do so restarts the timeline. (W.S. 26-56-102(a))
• Requires health carriers to complete the credentialing process within sixty calendar days of receiving an application. The sixty-day period pauses if an application is incomplete and resumes after resubmission. (W.S. 26-56-102(b))
• Requires health carriers to provide written or electronic notice of the credentialing outcome to applicants at the conclusion of the process. (W.S. 26-56-102(b))
• Requires health carriers to reimburse credentialed providers for covered services provided beginning from when the completed application was received, if a contract is executed before services are provided. (W.S. 26-56-102(c))
• Specifies that health carriers are not required to approve any credentialing application, except as provided by W.S. 26-22-503. (W.S. 26-56-102(d))
• Directs the Department of Insurance to develop a uniform credentialing application for use by applicants and health carriers, with dental and vision insurance exempt from the requirement. (Sec. 2)
• Clarifies that the act does not require health carriers to violate or fail to meet standards or requirements of nationally recognized accrediting entities. (Sec. 3)
• Applies the credentialing standards to applications submitted to health carriers on or after July 1, 2025.