HF 3921

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/05/2026 04:54 p.m.

A bill for an act
relating to health; clarifying provider credentialing in health plan network;
amending Minnesota Statutes 2024, section 62Q.097, subdivision 2.

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

Section 1.

Minnesota Statutes 2024, section 62Q.097, subdivision 2, is amended to read:

Subd. 2.

Time limit for credentialing determination.

A health plan company that
receives an application for provider credentialing must:

(1) if the application is determined to be a clean application for provider credentialing
and if the health care provider submitting the application or the clinic or facility at which
the health care provider provides services requests the information, affirm that the health
care provider's application is a clean application and notify the health care provider or clinic
or facility of the date by which the health plan company will make a determination on the
health care provider's application;

(2) if the application is determined not to be a clean application, inform the health care
provider of the application's deficiencies or missing information or substantiation within
three business days after the health plan company determines the application is not a clean
application; deleted text begin and
deleted text end

(3) make a determination on the health care provider's clean application within 45 days
after receiving the clean application unless the health plan company identifies a substantive
quality or safety concern in the course of provider credentialing that requires further
investigation. Upon notice to the health care provider, clinic, or facility, the health plan
company is allowed 30 additional days to investigate any quality or safety concerns deleted text begin . deleted text end new text begin ; and
new text end

new text begin (4) after a health plan has reviewed an application for provider credentialing and the
application is found to be a clean application, the health care provider is then classified as
in the health plan's provider network.
new text end