AN ACT Relating to health care provider credentialing; adding a new section to chapter 48.43 RCW; and adding a new section to chapter 18.130 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1.  A new section is added to chapter 48.43 RCW to read as follows:

(1) A health carrier shall use the database selected pursuant to RCW 48.165.035 to accept and manage credentialing applications from health care providers.

(a) A health carrier shall make a determination approving or denying a credentialing application submitted to the carrier no later than fifteen days after receiving a complete application from a health care provider.

(b) If a health care provider submits an incomplete credentialing application to a health carrier, the carrier shall notify the health care provider in writing no later than five days after receipt of the application that the application is incomplete. The notice must explain what additions or corrections to the application are necessary for the application to be considered complete. This section does not require health carriers to approve a credentialing application or to place providers into a network.

(2) This section does not apply to credentialing delegation arrangements between facilities and health carriers.

(3) For purposes of this section, "credentialing" means the collection, verification, and assessment of whether a health care provider meets relevant licensing, education, and training requirements.

NEW SECTION.  Sec. 2.  A new section is added to chapter 18.130 RCW to read as follows:

(1) When submitting a credentialing application to a health carrier, a health care provider shall submit the application to health carriers using the database selected pursuant to RCW 48.165.035.

(2) This section does not apply to providers practicing at a facility that has a credentialing delegation arrangement between the facility and a health carrier.

(3) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.

(a) "Credentialing" has the same meaning as in section 1 of this act.

(b) "Facility" has the same meaning as in RCW 48.43.005.

(c) "Health care provider" has the same meaning as in RCW 48.43.005(23)(a).

(d) "Health carrier" has the same meaning as in RCW 48.43.005.

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