Missouri House Bill 2450 (HB 2450), the "Prompt Credentialing Act," would require every health carrier in the state to complete verification of a physician's credentials and to make a credentialing decision within 45 days after receiving a complete application. If a decision is not made within the timeframe, then the health carrier must grant provisional credentialing status until a final determination is made. The bill also requires health carriers to retroactively compensate physicians for services rendered since the date of his or her application.
Making credentialing decisions more efficient is certainly a positive step. However, did lawmakers adequately consider the factors that play into the credentialing process when setting this timeframe? For example, hospitals with a delegated agreement would have a hard time meeting a 45 day timeframe. Also, the 45 day window doesn't encourage physicians to complete the application any faster, since it is imposed on the credentialing verification process.
Finally, what if additional investigation needs to be done on a physician's record and the 45 day timeframe lapses? Are hospitals comfortable with having a member on the medical staff with provisional status if they are still investigating a possible "gap" in his or her file?
NAMSS will work with members in Missouri to ensure that any concerns are communicated to lawmakers before this piece of legislation is voted upon. The bill currently has a proposed effective date of August 2010.
What are your thoughts on this issue? Do you have a credentialing timeframe in your state? If so, how long is it, and have you run into any problems because of it? Share your thoughts in the comment field below this post on the NAMSS Blog website.
To read Missouri HB 2450, click here: