Assigned to HHS FOR COMMITTEE
ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
FACT SHEET FOR S.B. 1291
health insurers; provider; payment; claims
Purpose
Reduces the number of days a health insurer has to conclude the provider credentialing
process and requires insurers to provide written or electronic confirmation of receipt of a complete
or deficient credentialing application. Requires health insurers to pay claims for covered services
by a provider whose credentialing application has been approved by the insurer retroactively to
the date of the provider's complete credentialing application.
Background
Health care provider credentialing is the process whereby health care insurers collect,
verify and assess whether a provider meets relevant licensing, education and training requirements
to become or remain a participating provider. Insurers must conclude the process of credentialing
and loading an applicant's information into the insurer's billing system within 100 days of receipt
of an application. Insurers may not deny a claim for a covered service provided to a subscriber by
a participating provider who has a fully executed contract with a network plan if the services are
provided after the date of approval of the credentialing application (A.R.S. §§ 20-3451; 20-3453;
and 20-3456).
A health insurer is a disability insurer, group disability insurer, blanket disability insurer,
health care services organization, hospital service corporation, medical service corporation or
hospital, medical, dental and optometric service corporation, including the insurers designee but
excluding pharmacy benefit managers (A.R.S. § 20-3451).
There is no anticipated fiscal impact to the state General Fund associated with this
legislation.
Provisions
1. Reduces, from 100 to 45, the number of days a health care insurer has to conclude the process
of credentialing and loading an applicant's information into the insurer's billing system after
receiving a complete credentialing application.
2. Requires health insurers to provide written or electronic confirmation within:
a) two business days upon receipt of a complete credentialing application; and
b) seven business days upon receipt of a credentialing application with deficiencies.
3. Requires health insurers to pay claims for covered services provided to a subscriber by a
participating provider who has a fully executed contract with a network plan if the provider's
credentialing application has been approved by the insurer retroactively to the date of the
provider's complete credentialing application. FACT SHEET
S.B. 1291
Page 2
4. Defines complete credentialing application as the submission of a health plan's credentialing
application, including any supporting documents.
5. Makes technical and conforming changes.
6. Becomes effective on the general effective date.
Prepared by Senate Research
February 7, 2025
MM/slp