HB1288
To Amend The Arkansas Health Care Consumer Act; And To Require A Healthcare Insurer To Make Certain Retroactive Payments To A Provider Upon Credentialing Of A Provider.
AI-Generated Summary
This bill proposes an amendment to the Arkansas Health Care Consumer Act. It mandates that healthcare insurers treat an applicant physician as a participating physician from the date a substantially completed application is submitted, provided the physician is subsequently approved through the insurer's credentialing process. This provision aims to ensure payment for services rendered during the period between application submission and formal credentialing approval. The "date of submission of a substantially completed application" is defined as the date the insurer receives the physician's credentialing information from the Centralized Credentials Verification Service of the Arkansas State Medical Board. However, this requirement explicitly excludes the Arkansas Medicaid Program. The purpose is to address retroactive payment responsibilities for healthcare insurers towards providers.
Potential Impact Analysis
Who Might Benefit?
The primary beneficiaries of this bill, if enacted, would be physicians seeking to become participating providers with healthcare insurers. By requiring insurers to recognize physicians as participating from the date of a substantially completed application submission, physicians can receive payment for services rendered during the often lengthy credentialing process. This could lead to improved cash flow for medical practices and potentially reduce administrative burdens associated with billing for services before formal approval.
Who Might Suffer?
The group most likely to be directly and negatively impacted by this bill is healthcare insurers, with the exception of the Arkansas Medicaid Program. Insurers will be required to make retroactive payments to providers for services rendered during the credentialing period, which could lead to increased financial exposure and potential administrative costs associated with processing these retrospective claims. The shift in payment responsibility could also necessitate adjustments in their actuarial assumptions and financial planning.