September 3, 2020
This spring, the Washington Legislature passed House Bill 1552 which sets requirements on health carriers regarding provider credentialing and retroactive reimbursement during the credentialing period. Here is a summary of the law:
Credentialing requirements
This legislation requires all health plans to use the database created and maintained by OneHealthPort/Provider Source for provider credentialing. Premera already relies on OneHealthPort for non-delegated credentialing, so this requirement didn’t change how we work with providers.
Retroactive reimbursement
The law requires carriers to pay for covered services provided to the member during the credentialing process at the in-network benefit level and under the terms of the contract. To apply, the credentialing application must ultimately be approved by the carrier.
Reimbursement would start on the date the completed credentialing application is received by the carrier or the effective date of the contract between the provider and the carrier; whichever is later.
If the credentialing application is denied or there isn’t a contract in effect between the provider and the carrier on the date of service, the services will be considered out-of-network and paid as such.
About OneHealthPort
OneHealthPort (OHP) was created for the local healthcare community. With OHP's single sign-on access, healthcare professionals have a single, easy, and secure way to access provider portals of major local health plans and hospitals. To learn more about getting OHP access, talk to your practice manager.
Learn more about credentialing and contracting
Our Join Our Network page gives you credentialing forms and a credentialing checklist. If you're new to working with Premera, our Learning Center has web-based orientation trainings, user guides, tip sheets, and more.