health insurers; provisional provider credentialing

SB1228 - health insurers; provisional provider credentialing

Healthcare

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Brian Fernandez
Last action: 2026-01-21
Official status: Senate second read
Effective date: Not listed

Plain English Breakdown

Checked against official source text during the last sync.

Health Insurers; Provisional Provider Credentialing

The bill requires health insurers to grant provisional credentialing to providers who meet specific criteria and sets reimbursement requirements during this period.

What This Bill Does

Requires health insurers to give provisional credentialing to a provider when they submit a complete application.
Specifies that the provisional credentialing starts on the day the insurer receives the complete application.
States that during provisional credentialing, the insurer must pay claims at rates set in their contract with the group practice or healthcare institution.
Limits the provisional credentialing period to 60 days unless the insurer approves or denies the full credentialing application earlier.

Who It Names or Affects

Health insurers
Providers who submit complete credentialing applications

Terms To Know

Provisional Credentialing: A temporary approval given to a provider by an insurer while the full credentialing process is being completed.
Provider: A healthcare professional or organization that provides medical services.

Limits and Unknowns

The bill applies only to applications submitted on and after December 31, 2026.
It does not specify what happens if a provider's application is denied during the provisional period.

Bill History

2026-01-21 Senate
Senate second read
2026-01-20 Senate
Senate Rules: None
2026-01-20 Senate
Senate Finance: None
2026-01-20 Senate
Senate first read

Official Summary Text

SB1228 - health insurers; provisional provider credentialing

Current Bill Text

Read the full stored bill text

SB1228 - 572R - I Ver

REFERENCE TITLE:
health insurers; provisional provider credentialing

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SB 1228

Introduced by

Senator
Fernandez

AN
ACT

amending title 20, chapter 27, article 1,
arizona revised statutes, by adding section 20-3460; relating to provider
credentialing.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 27, article 1,
Arizona Revised Statutes, is amended by adding section 20-3460, to read:

START_STATUTE
20-3460.

Provisional credentialing; reimbursement requirements; definition

A. A health insurer shall grant
provisional credentialing to a provider that begins on the date the health
insurer receives a complete credentialing application from the provider, if the
provider:

1. Is licensed in this state and in
good standing.

2. Has been credentialed by a
licensed health care institution's medical staff office or a credentialing
verification organization.

3. Has joined a group practice or
health care institution that has an existing contract with a health insurer.

B. During the provisional
credentialing period, a health insurer shall pay all claims that are submitted
by the provider at the rates established in the contract between the health
insurer and the group practice or health care institution.

C. Provisional credentialing remains
in effect until the earlier of either:

1. The health insurer's approval or
denial of the provider's complete credentialing application.

2. Sixty days after the date the
complete credentialing application was submitted.

D. If a health insurer denies a
complete credentialing application, the health insurer is not responsible for
reimbursing claims for services that were provided after the date of the denial
and may not recover monies paid for claims that were submitted during the
provisional credentialing period unless the claims were fraudulent.

E. For the purposes of this section,
"Health care institution" has the same meaning prescribed in section
36-401.
END_STATUTE

Sec. 2.
Applicability

This act applies to credentialing
applications that are submitted beginning from and after December 31, 2026.