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| | | An Act To Improve the Process of Credentialling Health Care |
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| | | Be it enacted by the People of the State of Maine as follows: |
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| | | Sec. 1. 24-A MRSA §4303, sub-§2, as amended by PL 1997, c. 163, §1, is | | further amended to read: |
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| | | 2. Credentialling. The credentialling of providers by a | carrier offering a managed care plan | | subsection. |
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| | | 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. |
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| | | 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. |
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| | | 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 |
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