Sec. 1. 24-A MRSA §4303, sub-§2, as amended by PL 1997, c. 163, §1, is further amended to read:

2. Credentialling. The credentialling of providers by a carrier offering a managed care plan is governed by this subsection.

A. The granting of credentials must be based on objective standards that are available to providers upon application for credentialling. A carrier shall consult with appropriately qualified health care professionals in developing its credentialling standards.

B. All credentialling decisions, including those granting, denying or withdrawing credentials, must be in writing. The provider must be provided with all reasons for the denial of an application for credentialling or the withdrawal of credentials. A withdrawal of credentials must be treated as a provider termination and is subject to the requirements of subsection 3-A.

C. A carrier shall establish and maintain an appeal procedure, including the provider's right to a hearing, for dealing with provider concerns relating to the denial of credentialling for not meeting the objective credentialling standards of the plan and the contractual relationship between the carrier and the provider. The superintendent shall determine whether the process provided by a carrier is fair and reasonable. This procedure must be specified in every contract between a carrier and a provider or between a carrier and a provider network if a carrier does not contract with providers individually.

D.__A carrier shall make credentialling decisions, including those granting, denying or withdrawing credentials, within 60 days of receiving a completed credentialling application from a provider.__For the purposes of this paragraph, an application is completed if the application includes all of the information required by the uniform credentialling application used by carriers and providers in this State, and such attachments to that application as required by the carrier at the time of application. A carrier may not require that a provider have an address within the State before accepting an application.__A carrier must accept primary source verification from the Federation of State Medical Boards or its successor organization.