Health care coverage: health care provider credentials.

Assembly Member Bennett's proposal to standardize health care provider credentialing in California establishes new requirements for health plans and insurers to process applications within specific timeframes. The legislation requires both the Department of Managed Health Care and Department of Insurance to adopt the Council for Affordable Quality Healthcare's standardized credentialing form by January 2028.

Under the new requirements, health plans and insurers must make credentialing determinations within 90 days of receiving completed provider applications. Plans must notify applicants within 10 business days whether their submission is complete and activate approved providers within 10 days of approval. If plans fail to meet the 90-day timeline, providers receive provisional 120-day approval unless they face licensing discipline, have adverse actions or malpractice reports, or lack prior credentialing history with the plan in the past five years.

The bill mandates that health plans and insurers transition to the standardized form within six months of its adoption. While plans may request clarifying information from providers, who must respond within 10 business days, the legislation directs plans to minimize additional documentation requests. The departments must update the credentialing form to align with CAQH changes and relevant legal requirements, though these updates are exempt from Administrative Procedure Act requirements.