HB1354: HB1354 Surprise Billing Consumer Protection Act; require certain health insurers providing a network plan to approve credentialing applications within a certain time frame

When a doctor or other healthcare provider wants to join an insurance company's network, the insurer first has to verify their licenses, training, and history through a process called credentialing. Currently Georgia law does not set a firm deadline for insurers to finish this review, which can leave providers waiting and potentially delay patient access to in-network care. This bill amends Georgia's insurance code (O.C.G.A. Title 33, Chapter 24) to require every health insurer to approve a complete credentialing application within 45 days of receiving it, as long as it follows rules set by the Department of Insurance. It also directs the Department of Insurance and the Department of Community Health to work with stakeholders to build one standardized credentialing application, possibly linked to the system already used to verify providers for Georgia's Medicaid program. Insurers must start using that standardized form by July 1, 2027, and the department must issue implementing rules by January 1, 2027. The overall law would take effect July 1, 2026.

• Requires every health insurer in Georgia to approve a complete credentialing application from a healthcare provider within 45 days of receiving it.
• Defines 'complete credentialing application' and 'credentialing' for purposes of this new Code section (O.C.G.A. § 33-24-37).
• Directs the Department of Insurance and the Department of Community Health to coordinate with stakeholders to create one standardized credentialing application.
• Requires all health insurers to start using that standardized application no later than July 1, 2027.
• Requires the Department of Insurance to adopt rules and regulations implementing the new requirements by January 1, 2027.
• Sets the law's overall effective date as July 1, 2026.

Health insurance companies that offer network plans in Georgia, healthcare providers such as doctors and other clinicians seeking to join insurer networks, the Department of Insurance, and the Department of Community Health, which oversees the state Medicaid program's verification system.

Faster, more predictable credentialing approvals could let providers start seeing patients in-network sooner, potentially easing delays that contribute to surprise billing when a provider isn't yet recognized as in-network. A single standardized application could also reduce paperwork burdens on providers dealing with multiple insurers.

• Section 1 rewrites O.C.G.A. § 33-24-37 to define 'complete credentialing application' and 'credentialing.'
• Subsection (b) requires insurers to approve complete applications within 45 days if submitted per Department of Insurance rules.
• Subsection (c) requires the Department of Insurance and Department of Community Health to coordinate with stakeholders on a standardized application, possibly tied to the Medicaid credentialing verification system.
• Subsection (d) requires insurers to use the standardized application by July 1, 2027.
• Subsection (e) requires the Department of Insurance to issue implementing rules and regulations by January 1, 2027.
• Section 2 sets the Act's effective date as July 1, 2026.
• Section 3 repeals conflicting laws.

1. 2026-02-25House Committee Favorably Reported By Substitute (House)
2. 2026-02-20House Second Readers (House)
3. 2026-02-19House First Readers (House)
4. 2026-02-18House Hopper (House)

• Trey Kelley (R, HD-016)Primary sponsor
• James Hatchett (R, HD-155)
• Mark Newton (R, HD-127)

• surprise billing
• health insurance regulation
• provider credentialing
• insurance networks
• Department of Insurance