Health care coverage: health care provider credentials.

Assembly Member Bennett's healthcare credentialing reform legislation establishes new timelines and standardization requirements for provider credentialing by California health plans and insurers. The Department of Managed Health Care and Department of Insurance must develop standardized credentialing forms and streamlined procedures by January 2028, which all full-service health plans and insurers will be required to adopt within six months of completion.

The bill mandates that health plans and insurers make credentialing determinations within 90 days of receiving completed applications, with notifications required within 10 business days to confirm receipt and application completeness. Providers must be activated and notified within 10 days of approval if it occurs before the 90-day deadline. Applications not processed within 90 days receive provisional 120-day approval, except for providers subject to licensing discipline, those with adverse actions or malpractice reports in the National Practitioner Data Bank, or those not credentialed by the plan in the past five years.

To reduce administrative burden, plans and insurers may only request additional information to clarify or verify details provided on the standard form, and providers have 10 business days to respond. The departments must coordinate to ensure consistency in standards and forms, which will be available electronically. The requirements exclude certain state healthcare contracts, and form updates are exempt from standard administrative procedures to allow rapid modifications when regulations change.