HF3921
Provider credentialing in health plan network clarified.
Legislative Session 94 (2025-2026)
AI Generated Summary
Purpose
This bill clarifies and standardizes how health plans review and decide on provider credentialing for their networks. It establishes clear timeframes and procedures for what counts as a clean application, how quickly deficiencies must be reported, and how long investigations can take when there are quality or safety concerns.
Main Provisions
Clean vs. not clean application
- When a health plan receives a credentialing application, it must determine whether the application is a clean application.
- If the application is clean, the provider or the clinic/facility that uses the provider must be notified of the date by which the plan will make a determination.
Deficiencies for not-clean applications
- If the application is not clean, the health plan must inform the provider of deficiencies or missing information within 3 business days after it is determined not to be clean.
Timeframe to decide on a clean application
- The health plan must determine a clean application within 45 days after receiving it, unless the plan identifies substantive quality or safety concerns that require further investigation.
Extensions for quality or safety concerns
- If there are substantive quality or safety concerns, the health plan may extend the investigation by up to 30 additional days after notice.
Outcome: in-network status
- Once a clean application has been reviewed and approved, the provider is classified as being in the health plan’s provider network.
Significant Changes to Existing Law
- Adds specific deadlines for credentialing actions (3 business days for deficiencies notice; 45 days to decide on a clean application; 30-day extension for investigations).
- Defines and clarifies what constitutes a clean vs. not-clean credentialing application.
- Clarifies the process and timing for when a health plan determines a provider is in-network.
How this affects providers and clinics
- Providers and clinics will have clearer expectations about how long credentialing decisions take and when they will be notified if something is missing.
- The process may speed up in-network status for providers who meet the criteria, while allowing extra time for legitimate quality or safety investigations.
Relevant Terms
clean application; deficiencies; missing information; substantiation; health plan company; health care provider; clinic or facility; provider credentialing; provider network; credentialing determination; time limits; quality or safety concern; investigation; notification; in-network.
Bill text versions
- Introduction PDF PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| March 02, 2026 | House | Action | Introduction and first reading, referred to | Health Finance and Policy | |
| March 05, 2026 | House | Action | Author added |
Citations
[
{
"analysis": {
"added": [
"Requires health plan to notify the provider, clinic, or facility of the date by which a determination will be made for a clean application.",
"Requires deficiencies or missing information to be communicated within three business days for non-clean applications.",
"Imposes a 45-day deadline to determine the health care provider's clean application, subject to possible extension for substantive quality or safety concerns.",
"Allows an additional 30 days to investigate quality or safety concerns after notice.",
"For a clean application, the health plan classifies the provider as in-network."
],
"removed": [],
"summary": "This bill amends Minnesota Statutes 2024 section 62Q.097, subdivision 2, to specify credentialing timelines for health plan provider credentialing, including handling of clean vs non-clean applications, notification of determinations, and 45-day and 30-day extension windows, culminating in in-network classification after review of a clean application.",
"modified": [
"Modifies the credentialing timeline and determination process codified in Minn. Stat. § 62Q.097, subd. 2."
]
},
"citation": "Minn. Stat. 62Q.097, subd. 2",
"subdivision": "Subd. 2"
}
]Progress through the legislative process
In Committee