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REFERENCE TITLE: health insurers; provisional provider credentialing |
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State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
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SB 1228 |
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Introduced by Senator Fernandez
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AN ACT
amending title 20, chapter 27, article 1, arizona revised statutes, by adding section 20-3460; relating to provider credentialing.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 27, article 1, Arizona Revised Statutes, is amended by adding section 20-3460, to read:
20-3460. Provisional credentialing; reimbursement requirements; definition
A. A health insurer shall grant provisional credentialing to a provider that begins on the date the health insurer receives a complete credentialing application from the provider, if the provider:
1. Is licensed in this state and in good standing.
2. Has been credentialed by a licensed health care institution's medical staff office or a credentialing verification organization.
3. Has joined a group practice or health care institution that has an existing contract with a health insurer.
B. During the provisional credentialing period, a health insurer shall pay all claims that are submitted by the provider at the rates established in the contract between the health insurer and the group practice or health care institution.
C. Provisional credentialing remains in effect until the earlier of either:
1. The health insurer's approval or denial of the provider's complete credentialing application.
2. Sixty days after the date the complete credentialing application was submitted.
D. If a health insurer denies a complete credentialing application, the health insurer is not responsible for reimbursing claims for services that were provided after the date of the denial and may not recover monies paid for claims that were submitted during the provisional credentialing period unless the claims were fraudulent.
E. For the purposes of this section, "Health care institution" has the same meaning prescribed in section 36-401.
Sec. 2. Applicability
This act applies to credentialing applications that are submitted beginning from and after December 31, 2026.