Provider credentialing in health plan network clarified.

A bill for an act

relating to health; clarifying provider credentialing in health plan network;

amending Minnesota Statutes 2024, section 62Q.097, subdivision 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62Q.097, subdivision 2, is amended to read:

Subd. 2.

Time limit for credentialing determination.

A health plan company that

receives an application for provider credentialing must:

(1) if the application is determined to be a clean application for provider credentialing

and if the health care provider submitting the application or the clinic or facility at which

the health care provider provides services requests the information, affirm that the health

care provider's application is a clean application and notify the health care provider or clinic

or facility of the date by which the health plan company will make a determination on the

health care provider's application;

(2) if the application is determined not to be a clean application, inform the health care

provider of the application's deficiencies or missing information or substantiation within

three business days after the health plan company determines the application is not a clean

application;
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and
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(3) make a determination on the health care provider's clean application within 45 days

after receiving the clean application unless the health plan company identifies a substantive

quality or safety concern in the course of provider credentialing that requires further

investigation. Upon notice to the health care provider, clinic, or facility, the health plan

company is allowed 30 additional days to investigate any quality or safety concerns
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.
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; and
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(4) after a health plan has reviewed an application for provider credentialing and the

application is found to be a clean application, the health care provider is then classified as

in the health plan's provider network.

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