Section 991.2121 - Procedures(a) A managed care plan shall establish a credentialing process to enroll qualified health care providers and create an adequate provider network. The process shall be approved by the department and shall include written criteria and procedures for initial enrollment, renewal, restrictions and termination of credentials for health care providers.(b) The department shall establish credentialing standards for managed care plans. The department may adopt nationally recognized accrediting standards to establish the credentialing standards for managed care plans.(c) A managed care plan shall submit a report to the department regarding its credentialing process at least every two (2) years or as may otherwise be required by the department.(d) A managed care plan shall disclose relevant credentialing criteria and procedures to health care providers that apply to participate or that are participating in the plan's provider network. A managed care plan shall also disclose relevant credentialing criteria and procedures pursuant to a court order or rule. Any individual providing information during the credentialing process of a managed care plan shall have the protections set forth in the act of July 20, 1974 (P.L. 564, No. 193), known as the "Peer Review Protection Act."(e) No managed care plan shall exclude or terminate a health care provider from participation in the plan due to any of the following:(1) The health care provider engaged in any of the activities set forth in section 2113(c).(2) The health care provider has a practice that includes a substantial number of patients with expensive medical conditions.(3) The health care provider objects to the provision of or refuses to provide a health care service on moral or religious grounds.(f) If a managed care plan denies enrollment or renewal of credentials to a health care provider, the managed care plan shall provide the health care provider with written notice of the decision. The notice shall include a clear rationale for the decision.1921, May 17, P.L. 682, No. 284, § 2121, added 1998, June 17, P.L. 464, No. 68, § 1, effective 1/1/1999.