SB 1291
Initials AG Page 1 Health & Human Services
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-seventh Legislature
First Regular Session
Senate: HHS DPA/SE 6-0-1-0 | 3rd Read 29-0-1-0
SB 1291: health insurers; provider credentialing; claims
Sponsor: Senator Angius, LD 30
Committee on Health & Human Services
Overview
Makes modifications to deadlines of the health insurance provider credentialing process and
outlines requirements for processing of claims effective April 1, 2026.
History
A health insurer includes a disability insurer, group disability insurer, blanket disability
insurer, health care services organization, hospital service corporation, medical service
corporation or a hospital, medical, dental and optometric service corporation and health
insurer's designee (A.R.S. § 20-3451).
Health care provider credentialing is a process used by health insurers to collect, verify and
assess whether a provider meets relevant licensing, education and training requirements to
become or remain a participating provider. Health 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. Health insurers are prohibited from denying 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. Title 20, Chapter 27).
Provisions
1. Requires a health insurer to:
a) conclude the provider credentialing process within 60 calendar days; and
b) load the applicant's information into the insurer's billing system within 30 calendar
days, rather than 100 calendar days, upon receipt of a complete credentialing
application. (Sec. 2)
2. Requires a health insurer, within seven calendar days of receiving a credentialing
application, to:
a) contact the applicant in writing or electronically to acknowledge receipt of the
application; and
b) inform the applicant whether the application is a complete credentialing application.
(Sec. 3)
3. Requires credentialing applicants to include the email address of an individual who can
address discrepancies in the application. (Sec. 3)
4. Specifies that a health insurer must include a detailed list of all incomplete items in its
incomplete credentialing application notices. (Sec. 3)
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note SB 1291
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5. Specifies that, if a credentialing application is incomplete and requires additional
information from the applicant, the health insurer must:
a) contact the applicant within seven calendar days to acknowledge receipt of the
submitted additional information; and
b) inform the applicant whether the application is complete. (Sec. 3)
6. Requires health insurers to communicate the withdrawal of an application to the
applicant within 7 calendar days, if the insurer has not received any response from the
applicant providing the requested information within 30 calendar days. (Sec. 3)
7. Specifies that, if the time period for processing a credentialing application is tolled while
the health insurer waits for additional information, the health insurer must acknowledge,
in writing or electronically, receipt of the additional information within seven calendar
days. (Sec. 3)
8. Forbids health insurers from tolling the required application processing time period more
than three times. (Sec. 3)
9. Permits a health insurer to deem an application withdrawn if, after the third toll, the
insurer has not received a response from the applicant with additional information within
30 calendar days. (Sec. 3)
10. Permits a provider to receive payment from a health insurer for services provided from
the date included on the notice of a complete credentialing application to the date the
provider's network participation contract is executed. (Sec. 5)
11. Directs a health insurer to process a provider's claim as an in-network claim and pay the
claim if the provider:
a) has applied for credentialing and renders a covered service to an individual who is an
eligible health plan member on the date of service;
b) renders the service on or after the date that the health insurer notified the provider
of a complete credentialing application; and
c) does not submit the claim until after the provider has a fully executed network
participation contract with the health insurer for the member's health plan network
and the health insurer has approved the provider's credentials. (Sec. 5)
12. Forbids, for claims submitted within one year after the date of service, health insurers
from denying a provider's claim that is submitted in compliance with statute on the basis
that the claim was not submitted within the contractually required time period. (Sec. 5)
13. Clarifies that health insurers are not required to reimburse an applicant at the in-
network rate for any covered medical services provided by the applicant if the applicant's
credentialing application is not approved or the health care provider is unwilling to
contract with the insurer on mutually acceptable terms. (Sec. 5)
14. Requires, within a reasonable period before a health care provider provides services to a
patient in a network facility, the provider or the provider's representative to provide a
written, dated disclosure that includes:
a) the name of the billing health care provider;
b) the total estimated cost to be billed by the health care provider or the provider's
representative; and
c) a statement that the provider is not credentialed and is not a contract provider.
(Sec. 5) SB 1291
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15. Excludes a health insurer that does not credential a provider from civil liability for any
act or omission of the provider in rendering services to a member. (Sec. 6)
16. Repeals statute that prohibits a health insurer from denying 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. (Sec. 4)
17. Redefines credentialing as a complete credentialing application that includes:
a) all information, any required supporting documentation and a current authorization
to access electronic documentation that a health insurer needs in order to process the
credentialing request through a credentialing system that is developed by a nationally
recognized alliance of health plans and trade associations; and
b) a nonprofit organization that is incorporated as a mutual health care corporation that
is working to streamline the business of health care. (Sec. 1)
18. Revises the definition of participating provider to include a provider that has been
contracted by a health insurer to provide health care items or services to subscribers.
(Sec. 1)
19. Makes technical and conforming changes. (Sec. 1-3 and 6)
20. Contains an effective date of April 1, 2026. (Sec. 7)