Pennsylvania Senate Bill SB888

Pennsylvania 2025-2026 Regular Session

• Introduced: 6/24/25
• Refer: 6/24/25

Caption

Providing for the use of certain credentialing applications and for credentialing requirements for health insurers; imposing penalties; and conferring powers and imposing duties on the Insurance Department.

Summary

SB 888 would require Pennsylvania health insurers to accept the CAQH credentialing application, or another Insurance Department-designated nationally recognized credentialing form, when a health care practitioner seeks participation in a provider panel. It also requires practitioners to use that form and treats an application as complete when it is submitted through the CAQH electronic process or another approved process with all required information. The bill establishes specific timelines for insurer action: within 10 business days of receiving an application, the insurer must tell the practitioner whether it is complete or incomplete and explain any deficiencies; within 45 business days after receiving a complete application, the insurer must issue a credentialing determination and provide reasons if the practitioner is not credentialed. It also provides that if a practitioner with multiple practice locations is approved, the practitioner is automatically credentialed for all locations in the insurer’s provider panel. The Insurance Department is directed to adopt regulations and may assess administrative penalties for insurers that fail to use the required application process or intentionally and routinely fail to complete credentialing on time.

Impact

SB 888 would amend Pennsylvania insurance law by standardizing the credentialing application process for health insurers and expanding the Insurance Department’s oversight authority. It would apply to licensed health insurers, including Medicaid managed care organizations, while excluding various limited-scope products such as accident-only, vision, Medicare supplement, workers’ compensation, and similar coverages. The bill would not require insurers to admit any provider into a network, but it would impose procedural obligations and potential penalties for noncompliance, affecting insurer credentialing operations, provider onboarding, and the administrative handling of practitioner applications, including those from federally qualified health centers and dentists.

Sentiment

Based on the bill text and the absence of recorded committee testimony or votes, the overall sentiment appears to be pro-administrative efficiency and provider access. The measure is framed as a process-improvement bill intended to reduce delays and inconsistency in credentialing, which would likely be attractive to health care practitioners and provider organizations. At the same time, the bill preserves insurer discretion over network participation, suggesting an attempt to balance provider concerns with insurer operational control.

Contention

The main point of contention is likely to be the bill’s mandatory timelines and penalty provisions, which could be viewed by insurers as burdensome or as limiting flexibility in credentialing review. Insurers may also object to the automatic credentialing of practitioners across multiple locations after one approval, depending on how that affects network administration and oversight. On the provider side, the bill explicitly does not guarantee network participation or create any right to be accepted by an insurer, so advocates seeking stronger access protections may view it as insufficient. No specific opposition or support was recorded in the provided materials.