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Guide

Getting Paid While Credentialing Is Pending: Oregon And The Western States

Oregon makes insurers pay for covered care from the day your complete credentialing application arrives. How Washington, California and the West compare.

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Credentialing

In Oregon, once a PPO or managed care insurer has your complete credentialing application, it has 90 days to approve or reject it, and it has to pay for the covered care you deliver during that wait. Washington, Arizona, New Mexico and Wyoming have their own versions, each with a condition that decides whether you get paid. California, Utah and Colorado set deadlines without any back pay. Idaho, Nevada, Montana, Alaska and Hawaii have no state deadline or pay rule that we found.

The Oregon Rule, In Plain Terms

ORS 743B.454 starts a clock the day a health insurer receives your complete application. The insurer has 90 days to approve or reject it. The law calls the time between those two points the credentialing period, and it ends at the decision or on day 90, whichever comes first.

Every covered service you provide during that period is payable. You can send those claims while you wait or after the decision, and as long as they go in within six months after the credentialing period ends, the insurer can’t deny them for timely filing.

The insurer is allowed to pay those visits at the rate it pays out of network providers. A 2025 amendment, House Bill 3242, changed that for one common case: a clinician joining a group that’s already in network with the insurer is paid the in network rate during the credentialing period. The group owes back the difference if the application turns out to be incomplete or the clinician isn’t approved, and the insurer has to tell the clinician within 90 days if something is missing.

Complete has a definition. Oregon counts an application as complete when it includes everything that insurer requires, proof of a license from an Oregon health professional regulatory board, current DEA registration if you need one, and proof of professional liability coverage that meets the insurer’s requirements.

The date that matters is the day the insurer received your complete application, not the day you mailed it or clicked submit. Get that date in writing from each insurer and keep it with the file.

The rule covers insurers selling managed health insurance and PPO coverage. HMOs aren’t included, and neither is the Oregon Health Plan, which runs its own enrollment, with retroactive enrollment rules of its own under OAR 410-120-1260. A clinician the insurer previously rejected or terminated for failing to meet professional standards, after a chance to contest it before a peer panel, is also excluded. Our Oregon credentialing guide covers the payers one by one.

What The Law Leaves To You

A state rule like Oregon’s protects the dates. It doesn’t load you into the insurer’s systems, and it doesn’t tell you how each insurer wants those claims.

Credentialing approval and being able to bill in network are separate events. After approval, the contract has to be executed and your record loaded into the insurer’s claims system, its payment setup and its directory. For a new provider signing a first contract, that part often takes longer than the credentialing itself, and every insurer runs it differently. Until your record is loaded, a claim can deny or process as out of network and then has to be worked again.

Holding claims is a state by state and insurer by insurer question. Oregon lets you submit claims for the credentialing period during or after it. Arizona makes holding a condition of being paid back. Washington pays once credentialing is complete. Whatever the state, confirm with each insurer how it wants those claims and that your contract is loaded before you switch your billing over.

  • Record the date each insurer received your complete application, in writing.
  • Ask each insurer how it processes claims for the pending period, and write down who told you.
  • Confirm the contract is executed and your record is loaded before routine in network billing.
  • Track the six month window after the credentialing period ends, or your state’s equivalent.
  • Send one test claim to each insurer before you switch everything over.

How Oregon Compares Across The West

These are commercial insurance rules. Self funded employer plans and Medicare Advantage generally sit outside state insurance law, and Medicaid plans run their own enrollment, so confirm which plan type you’re dealing with before you rely on a row.

StateDecision DeadlinePaid For Care While Pending?What To WatchLaw
Oregon90 days from a complete applicationYes, for covered care from the day the complete application arrives until the decision or day 90. Out of network rate allowed, in network for a clinician joining an in network group.Claims can go in during or after the period, with six months after it ends. HMOs and the Oregon Health Plan aren’t covered.ORS 743B.454, as amended by HB 3242 (2025)
Washington90 days from a complete application, with decisions averaging no more than 60Yes, once approved, at the contract rate. Back to the application date when you join a contract your group already has, or to the contract’s effective date for a new contract.Payment comes on completion, so plan to hold or rebill those claims.RCW 48.43.750, 48.43.757
California60 days for mental health and substance use providers. 90 days for other providers under AB 1041, in effect January 1, 2026, with plans given a year to comply.No. Neither law pays for care before the contract.The timelines cover credentialing, not contracting. Under AB 1041 the plan has to activate you and tell you within 10 days of approval. Medi-Cal runs separately.Health and Safety Code 1374.197, 1374.198; Insurance Code 10144.56, 10144.565
Arizona7 days to acknowledge and list anything missing, 60 days to credential, and 30 days from the complete application to load you for billingYes, at the in network rate, from the date on the insurer’s notice that your application is complete.You have to hold the claims until you’re approved and your contract is fully executed, then file within a year of the date of service. Before you treat a patient in a network facility, give them a written, dated notice with your name, the estimated cost, and a statement that you aren’t credentialed or contracted yet. In effect since April 1, 2026.A.R.S. 20-3453, 20-3454, 20-3456 (SB 1291, 2025)
New Mexico30 days to decide and load you into payment systems and the directory, 45 when a file is flaggedIf the insurer decides or loads you late, services more than 30 days after it received the complete application are paid at its standard rate, or your group’s contract rate.You have to send requested documents on time, carry malpractice coverage and have no license sanctions.NMSA 59A-22-54, 59A-23-14, 59A-46-54, 59A-47-49 (SB 232, 2023)
WyomingReceipt notice in 7 days, incomplete notice in 30, decision in 60, for applications filed on or after July 1, 2025Only if a signed contract is already in effect when you see the patient. Then, once you’re credentialed, you’re paid back to the date the insurer received your completed application.Get the contract signed early, because care before it takes effect isn’t covered by this rule.W.S. 26-56-101, 26-56-102
ColoradoReceipt in 7 days, incomplete notice in 10, decision in 60. A 2026 amendment extended this from physicians to mental health and substance use providers and psychiatric nurses.No back pay. If the insurer misses the 7 day receipt notice, you’re treated as participating by day 53.Starting in 2027, insurers must check once a year with behavioral health providers who haven’t billed in 12 months, and must drop those who don’t answer two requests.C.R.S. 10-16-705.7, as amended by HB26-1002, effective August 12, 2026
Utah120 days after the insurer has all necessary informationNo.Nothing on loading or claims while pending.Utah Code 31A-45-304
Idaho, Nevada, Montana, Alaska, HawaiiNo state deadline foundNo state deadline or pay rule found. The insurer’s contract and policy decide.Nevada requires the state’s standardized credentialing form.Checked October 11, 2026

How long each insurer takes is a separate question. Our credentialing timeline guide lists what each payer publishes, state by state.

Where We Come In

In our experience, these details often get skipped when the job is treated as filing applications and setting up accounts. They’re the ones that decide whether the visits a new provider sees during the wait ever get paid.

With AdvanceAPractice they’re part of the work. When we credential a provider, we record the date each insurer received the complete application, ask how that insurer wants the pending claims, and confirm when the contract is loaded, so you know the day you can bill in network. If someone else handles your medical billing, we walk you or your biller through the same steps for your practice and your insurers. You get answers about your own files, not a spreadsheet to figure out alone.

Questions We Get

Can I See Insurance Patients In Oregon Before I’m Credentialed?

With a commercial insurer covered by ORS 743B.454, covered care you provide after the insurer receives your complete application is payable while it decides, for up to 90 days. It may pay out of network rates unless you’re joining a group that’s already in network with it. HMOs and the Oregon Health Plan aren’t covered by this rule.

Should I Hold Those Claims Or Send Them?

It depends on the state and the insurer. Oregon lets you send them during or after the credentialing period. Arizona requires you to hold them until you’re approved and contracted. Washington pays once credentialing is complete. Ask each insurer how it wants them, and confirm your record is loaded before routine billing.

Is Credentialing Approval The Same As Being In Network?

No. After approval, the contract has to be executed and your record loaded into the insurer’s claims and payment systems. California’s newer law makes the plan activate you and tell you within 10 days of approval. Most states don’t set a loading deadline at all.

What Counts As A Complete Application In Oregon?

Everything the insurer requires, proof of an Oregon license from a health professional regulatory board, current DEA registration if you need one, and proof of professional liability coverage that meets the insurer’s requirements. The clock starts the day the insurer receives all of it.

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Every credentialing package has a published price and a written scope, priced per insurer, and Monthly plans are available at the same total, with no interest or fees. The guidance in this article comes with it: the dates, the claims and the contract load, explained for your practice.

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Sources

Every fact on this page comes from the source listed here, read on the date shown. This page covers payer operations, not legal advice. Laws and insurer policies change, so confirm the current rule before you rely on it.