Health & Saf. Code, § 1374.198 · Article 5. Standards
Health & Saf. Code, § 1374.198
Text — As published in the Legislative Counsel's database, tables dated October 18, 2026 (pubinfo_2025.zip)
(a) Except as provided in Section 1374.197, within one year of the operative date of this section, a health care service plan or its delegate that credentials health care providers for its networks shall make a determination regarding the credentials of a health care provider within 90 days after receiving a completed provider credentialing application, including all required third-party verifications. Upon receipt of the application by the credentialing department, the health care service plan or its delegate shall notify the applicant within 10 business days to verify receipt and inform the applicant whether the application is complete. The health care service plan shall activate the provider upon successful approval and notify the applicant of the activation within 10 days of approval if the approval occurs prior to the end of the 90-day timeline. The 90-day timeline shall apply only to the credentialing process and does not include contracting completion. If the health care service plan or its delegate does not meet the 90-day requirement, the applicant’s credentials shall be provisionally approved for 120 days unless any of the following apply:
(1) The applicant is subject to discipline by the licensing entity for that applicant.
(2) The applicant has one or more adverse action reports or one or more reports of malpractice payments filed with the National Practitioner Data Bank.
(3) The applicant has not been credentialed by the health care service plan in the past five years.
(b) This section does not apply to contracts with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of Welfare and Institutions Code.
Notes and commentary — not statutory text
History
Added by Stats. 2025, Ch. 630, Sec. 1. (AB 1041) Effective January 1, 2026.
Source of truth
- Edition
- As published in the Legislative Counsel's database, tables dated October 18, 2026 (pubinfo_2025.zip)
- Official file
- https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=1374.198.
- Text hash
- sha256 cb5930a2e70f267a2f873ff8cbbd2eb751b4a6a492f7ca713a1cdd57359c13e4
- Composed by
- compose_ca.py 2026-10-22: the Legislative Counsel's CAML content files read by a tokenizer (caml_readers.reader_a); an independent xml.etree reading (caml_readers.reader_b) agrees on every section
This section cites
Provisions in this library that the text above cites, as it prints each citation. A range cited as “ss. 61.13-61.16” links its first and last provisions.
Health and Safety Code
Welfare and Institutions Code
- Welf. & Inst. Code, div. 9, pt. 3, ch. 7Basic Health CarePrinted as Chapter 7 (commencing with Section 14000) … of Welfare and Institutions Code
- Welf. & Inst. Code, div. 9, pt. 3, ch. 8Prepaid PlansPrinted as Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of Welfare and Institutions Code
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.