House Bill 5343 Summary

• Requires health insurers to assess and issue written approval or denial decisions on mental health and substance use disorder provider credentialing applications within 60 calendar days of receiving a complete application, with an optional 15-day extension if serious issues like sanctions or convictions require additional review.

• Mandates insurers send written notification via certified mail within 10 business days of receiving incomplete applications, specifying all required information and providing a point of contact for the applicant.

• Requires insurers to load approved provider information into their payment systems and provider directories within the 60-day period (or 75 days with extension) to enable correct reimbursement according to contract terms.

• Obligates insurers to reimburse providers for claims with dates of service more than 60 days after submission of a complete application (45 days if extension applied) if the provider meets credentialing requirements and the insurer failed to make a timely decision, using standard in-network or median reimbursement rates.

• Applies the credentialing timeline requirements equally to initial applications and recredentialing applications, and defines "mental health or substance use disorder provider" to include psychiatrists, psychologists, social workers, marriage and family therapists, professional counselors, and behavior analysts licensed in Michigan.