HF 875 — A bill for an act relating to health insurers’ credentialing process.

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i u1!1lI lI1 •llI 11I¢I17 ¢I!l i!I!1 IllI II House File 875 AN ACT RELATING TO HEALTH INSURERS' CREDENTIALING PROCESS.

Section 11. .

514F.6 Credentialing rctr03pcctive—— paymcnt.retrospective payment.

A health insurer shall respond to a physician, advanced registered nurse practitioner, or physician assistant'sassistant’s request for credentialing within fifty-six calendar days from the date of the request.

If a physician's,physician’s, advanced registered nurse practitioner's,practitioner’s, or physician assistant'sassistant’s request for credentialing is denied by the health insurer, the health insurer shall provide a reason for the denial, in writing, to the physician, advanced registered nurse practitioner, or physician assistant.

2.

Advanced“Advanced registered nurse practitionerpractitioner” - means a person House File 875, .p.

b,b. -Clean claim"" means the same as defined in section 507B.4A, subsection 2 , paragraph " b-.

C.“Clean claim” means the same as defined in section 507B.4A, subsection 2, paragraph “b”.

-Credentialingc. - means a process through which a health insurer makes a determination based on criteria established by the health insurer concerning whether a physician, advanced registered nurse practitioner, or physician assistant is eligible to provide health care services to an insured and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, or physician assistant and the health insurer.

“Credentialing” means a process through which a health insurer makes a determination based on criteria established by the health insurer concerning whether a physician, advanced registered nurse practitioner, or physician assistant is eligible to provide health care services to an insured and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, or physician assistant and the health insurer.

-Credentialing“Credentialing periodperiod” - means the time period between the health insurer'sinsurer’s receipt of a physician's,physician’s, advanced registered nurse practitioner's,practitioner’s, or physician assistant'sassistant’s application for credentialing and approval of that application by the health insurer.

e,e. Physician -means a licensed doctor of medicine and surgery or a licensed doctor of osteopathic medicine and surgery.

f,“Physician” "Physicianmeans assistant"a meanslicensed thedoctor sameof asmedicine definedand insurgery sectionor 148C.1.a licensed doctor of osteopathic medicine and surgery.

PATf. GRASSLEY Speaker of t7e House President of the Senate I hereby certify that this bill originated in the House and is known as House File 875, Ninety-first General Assembly.

MEGAN“Physician NELSONassistant” Chimeans fthe lerksame Approvedas Wdefined kin esection ,148C.1. 2025 KIM R YNOLDS Governor

______________________________ ______________________________ PAT GRASSLEY AMY SINCLAIR Speaker of the House President of the Senate I hereby certify that this bill originated in the House and is known as House File 875, Ninety-first General Assembly.

______________________________ MEGHAN NELSON Chief Clerk of the House Approved _______________, 2025 ______________________________ KIM REYNOLDS Governor