House
File
875
-
Enrolled
House
File
875
AN
ACT
RELATING
TO
HEALTH
INSURERS’
CREDENTIALING
PROCESS.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
Section
1.
Section
514F.6,
Code
2025,
is
amended
to
read
as
follows:
514F.6
Credentialing
——
retrospective
payment
.
1.
Retrospective
payment.
The
commissioner
shall
adopt
rules
to
provide
for
the
retrospective
payment
of
clean
claims
for
covered
services
provided
by
a
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant
during
the
credentialing
period,
once
the
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant
is
credentialed.
2.
Credentialing
process.
a.
A
health
insurer
shall
respond
to
a
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant’s
request
for
credentialing
within
fifty-six
calendar
days
from
the
date
of
the
request.
b.
If
a
physician’s,
advanced
registered
nurse
practitioner’s,
or
physician
assistant’s
request
for
credentialing
is
denied
by
the
health
insurer,
the
health
insurer
shall
provide
a
reason
for
the
denial,
in
writing,
to
the
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant.
2.
3.
Definitions.
For
purposes
of
this
section
:
a.
“Advanced
registered
nurse
practitioner”
means
a
person
House
File
875,
p.
2
currently
licensed
as
a
registered
nurse
under
chapter
152
or
152E
who
is
licensed
by
the
board
of
nursing
as
an
advanced
registered
nurse
practitioner.
b.
“Clean
claim”
means
the
same
as
defined
in
section
507B.4A,
subsection
2
,
paragraph
“b”
.
c.
“Credentialing”
means
a
process
through
which
a
health
insurer
makes
a
determination
based
on
criteria
established
by
the
health
insurer
concerning
whether
a
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant
is
eligible
to
provide
health
care
services
to
an
insured
and
to
receive
reimbursement
for
the
health
care
services
provided
under
an
agreement
entered
into
between
the
physician,
advanced
registered
nurse
practitioner,
or
physician
assistant
and
the
health
insurer.
d.
“Credentialing
period”
means
the
time
period
between
the
health
insurer’s
receipt
of
a
physician’s,
advanced
registered
nurse
practitioner’s,
or
physician
assistant’s
application
for
credentialing
and
approval
of
that
application
by
the
health
insurer.
e.
“Physician”
means
a
licensed
doctor
of
medicine
and
surgery
or
a
licensed
doctor
of
osteopathic
medicine
and
surgery.
f.
“Physician
assistant”
means
the
same
as
defined
in
section
148C.1.
______________________________
PAT
GRASSLEY
Speaker
of
the
House
______________________________
AMY
SINCLAIR
President
of
the
Senate
I
hereby
certify
that
this
bill
originated
in
the
House
and
is
known
as
House
File
875,
Ninety-first
General
Assembly.
______________________________
MEGHAN
NELSON
Chief
Clerk
of
the
House
Approved
_______________,
2025
______________________________
KIM
REYNOLDS
Governor