Committee advances bill setting 60-day timeline for insurer credentialing of providers

The Labor, Health & Social Services Committee on Feb. 12 approved House Bill 82, a bill that would require health carriers to follow a set timeline for credentialing health-care providers and directs the Wyoming Department of Insurance to adopt rules and a standardized application form.

Committee Chairman Senator Barlow, chairman of the Labor, Health & Social Services Committee, summarized the measure as addressing delays in insurer credentialing: "This bill is about credentialing of providers by insurers, if you will. In this bill they're called health carriers. And it sets a timeline for when this credentialing needs to occur." He outlined the bill's key timelines, including an initial 7-day acknowledgement, a 30-day window for carriers to notify applicants of incomplete submissions and a 60-day deadline for a final credentialing determination from receipt of a completed application.

The bill grants the Department of Insurance rulemaking authority to implement the timelines and to create a universal application where appropriate. Jill Bridal, health policy analyst for the Department of Insurance, told the committee the agency has already begun outreach to insurers and is "looking to get a universal form that they can all agree with so that we hopefully can expedite the process." Bridal said the agency participated in discussions throughout the interim and would administer the application and rules described in the bill.

Representatives of insurers, providers and industry groups testified in support. Kerry Hall, president and CEO of Delta Dental of Wyoming, said dental and vision plans were excluded because their enrollment forms are much shorter and the required information differs from medical credentialing: "Our Delta Dental application is like two and a half pages long. It could be one page. We kind of keep it as simple as possible." Other insurers and plan administrators—speakers included Kelsey Prestesater of Blue Cross Blue Shield of Wyoming; Mike Mosier of Cigna; Denise Burke representing CVS Caremark and Aetna; and Sheila Bush of the Wyoming Medical Society—participated as part of a coalition that worked on the bill during the interim.

Eric Boley of the Wyoming Hospital Association said delays in credentialing can be lengthy and costly. "We've seen situations where we had new providers in the state that some of them had been waiting 160 days to get their credentialing done," he said, noting that Medicaid and Medicare processes are often faster and that a single, standardized form should reduce duplicative work by providers who currently complete different applications for each insurer.

The bill also includes a provision that, once a provider is credentialed and has a contract within a carrier's network, the carrier will reimburse for covered health-care services provided under that contract. Committee members asked for and received clarification that the bill allows a carrier to pause the 60-day period when an application is incomplete, and that the bill requires carriers to notify applicants when an application is incomplete within the earlier 30-day window described in the draft statute.

Senator Steinmetz moved to pass the bill out of committee. The committee approved House Bill 82 on a roll-call vote, recorded as four votes in favor with one member excused. Chairman Barlow said he would take the bill to the floor for consideration.

The committee closed public comment after hearing testimony and agreed to handle the bill without committee amendments.