Senate Bill 507, the OMA bill that establishes a statutory timeframe for credentialing decisions, went into effect July 23. Below you can find the specifics of the bill and how it may affect you.

Health plans now have 90 days to make decisions on a physician’s credentialing application. During the 90 day credentialing period, physicians will be able to see patients and be reimbursed at least at the non-participating provider rate. The credentialing period starts upon receipt of a complete application from the physician. A “complete application” must include:

• Proof of current registration with the DEA
• Proof that the provider is covered by a professional liability insurance policy or certification meeting the health insurer’s requirements
• Other information requested by the health insurer

If credentialed, physicians will be reimbursed for all covered medical services provided during and after the credentialing period. Timely filing issues are addressed in the bill and the physician will be reimbursed for providing covered medical services if they submit the claim within six months after the credentialing decision has been made.

Health plans will not be required to pay claims if the provider is not credentialed, the provider was previously rejected or terminated, or the provider fails to contest a rejection before a panel of peers.

For further questions or concerns, contact Bryan Boehringer at bryan@theOMA.org or Joy Conklin at joy@theOMA.org, or call (503) 619-8000.