LD 423
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Page 1 of 2 PUBLIC Law Chapter 108 LD 423 Title Page
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LR 750
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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 or denying credentials, within 60 days of
receipt of a completed credentialling application from a
provider. The time period for granting or denying
credentials may be extended upon written notification from
the carrier within 60 days following submission of a
completed application stating that information contained in
the application requires additional time for verification.
All credentialling decisions must be made within 180 days of
receipt of a completed application.__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, such attachments to that
application as required by the carrier at the time of
application and all corrections required by the carrier. A
carrier shall review the entire application before returning
it to the provider for corrections with a comprehensive list
of all corrections needed at the time the application is
first returned to the provider.__A carrier may not require
that a provider have a home address within the State before
accepting an application.

 
Sec. 2. Rulemaking. The Department of Professional and Financial
Regulation, Bureau of Insurance may amend Bureau of Insurance
Rule Chapter 850, Health Plan Accountability, to conform to the
requirements of this Act. Notwithstanding the Maine Revised
Statutes, Title 24-A, section 4309, rules adopted pursuant to
this section are routine technical rules as defined in Title 5,
chapter 375, subchapter 2-A.


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