New Law Simplifies Credentialing for Health Care Providers
Beginning this year, a new law should address two significant problems that have long plagued the credentialing process, which is the method insurance carriers use to ensure that a health care provider is qualified to provide services to their enrollees. Historically, health care providers have been required to provide different applications and information to each of the dozen or more carriers, and filling out and submitting these applications is a time-consuming process. Additionally, many providers have experienced significant delays in the processing of their applications.
However, the 2016 Washington legislation, HB 2335, will now address those two problems. Effective June 1, 2018, all Washington health carriers and health care providers will use a uniform application and a single, shared database for credentialing purposes. Further, those health carriers must process completed applications within 90 days of receipt. Effective June 1, 2020, the average response time may not exceed 60 days. See RCW 48.43.750; RCW 48.43.755.
Specifically, providers must submit applications using ProviderSource, a free tool that manages the process. The provider will use ProviderSource to build a complete professional profile, which will function as a universal credentialing and enrollment application. Once an application is submitted, insurance carriers have 90 days to approve it. Many experts believe the standardization will lead to processing times that are far faster than the initial 90-day ceiling.
If you have additional questions about the new credentialing process, please contact me at firstname.lastname@example.org or 206-682-7090.