Md. Code Regs. 31.10.41.04

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.10.41.04 - Assignment of Benefits - Hospital-Based Physicians

A. A nonpreferred provider who is a hospital-based physician may accept an assignment of benefits under a preferred provider insurance policy.

B. A nonpreferred provider who is a hospital-based physician and accepts an assignment of benefits under a preferred provider insurance policy shall:

(1) Accept the carrier's allowed amount as payment in full for the covered services provided;

(2) Collect or attempt to collect from the insured only the monies for the items identified in Insurance Article, § 14-205.2(b)(3), Annotated Code of Maryland; and

(3) Submit to the carrier the uniform claims form required by COMAR 31.10.11.03B and indicate acceptance of the assignment of benefits in box 27 of the uniform claims form to satisfy the notice requirements of Insurance Article, § 14-205.2(a)(3), Annotated Code of Maryland.

C. A carrier shall reimburse a nonpreferred provider who is a hospital-based physician and who has provided the information specified in §B(3) of this regulation in accordance with the provisions of Insurance Article, § 14-205.2(d), Annotated Code of Maryland.

Md. Code Regs. 31.10.41.04