California looks to streamline health plan credentialing

A bill enacted by California assemblyman Jim Wood would simplify the credentialing process for practitioners looking to join a health plan.

AB-815 calls for the creation of a state board to certify certain entities to act as delegated credentialing entity for health plans. Health plans would then use this credentialing information instead of conducting their own credentialing of a practitioner.

“This bill would require the California Health and Human Services Agency to create and maintain a provider credentialing board, with specified membership, to certify private and public entities for purposes of credentialing physicians and surgeons and other health care providers in lieu of a health care service plan’s or health insurer’s credentialing process.”

The new state board would consist of representatives from health plans and some of the state’s health departments, as well as physicians and other providers. The bill calls for the board to be put in place by July 1, 2024 and for the application process to become a certified entity to be put in place by July 1, 2025.

The bill has passed the California Assembly and now goes to the senate to vote on.