Legislation 1 | A New Legislation in Pennsylvania will Change Credentialing for Doctors and Practitioners | STATMedCare Payor and Physician Enrollment and Credentialing

credentialing for doctors and practitioners

While the healthcare industry is on the upward spiral, a mounting number of stakeholders are still grappling with various problems triggered by the complexity of credentialing and other financial compliances. Dealing with different operational challenges involved in efficiently managing complex multi-party arrangements for accelerating licensing and credentialing process for private practitioners and healthcare providers.

However, a new senate ruling was recently enforced in Pennsylvania, which focuses on making the credentialing process foolproof for healthcare service providers by eliminating the potential for unnecessary delays for credentialing applicants to be a part of health insurance organizations.

Representative Clint Owlett (R- Bradford, Tioga, Potter) introduced the House Bill 533 in the Pennsylvania House in November 2019, and it was passed unanimously (190-0). The legislation addresses a wide range of processes involved in the application of credentialing that must be completed by health care providers for becoming credentialed by a health insurer.

While insurance companies continue to impose their own time frames throughout the entire credentialing process a healthcare practitioner has to follow, the new legislation is expected to give this process a distinct deadline and a predictable timeframe. The senate ruling is expected to enable the Pennsylvania Medical Society and the ecosystem of healthcare practitioners and hospitals in the state to get credentialed by insurance companies faster.

The credentialing process that is currently followed in the healthcare industry in the region takes over six months for healthcare service providers to get credentialed. However, according to the new legislation, insurance companies will be enforced to finish the entire process of issuing a doctor’s credentials within 60 days, and failing to do so will lead to issuing a written explanation on reasons behind it. This is expected to expedite credentialing processes in Pennsylvania, changing the future trends in the healthcare industry as well as the healthcare credentialing insurance landscape.

The new legislation is likely to have a significant impact on how the healthcare industry operates in rural areas, as rural hospitals are always struggling to get qualified doctors and physicians. As credentialing and licensing are closely associated with how telehealth initiatives are implemented in rural communities, the new legislation will facilitate rural hospitals to effectively streamline their timelines of on-boarding and credentialing process for new and experienced physicians.

Taking into consideration the probable impacts of the new Bill for credentialing passed in Pennsylvania, more states in the United States are likely to ride on its coattails and impose similar regulations, in the coming years. Furthermore, as it supports rural hospitals to boost on-boarding and credentialing new doctors, the new regulation will create new profit-making opportunities for stakeholders to improve their organizations’ financial health.