Current with changes from the 2024 Legislative Session
Section 1-208 - Uniform claims forms(a)(1) In this section the following words have the meanings indicated.(2)(i) Except as otherwise provided in this paragraph, "health care practitioner" means a physician or any other person licensed or certified under this article and reimbursed by a third party payor.(ii) Subject to the provisions of subparagraph (iii) of this paragraph, "health care practitioner" does not include a physician or other person licensed or certified under this article who is compensated by a health maintenance organization on a salaried or capitated basis.(iii) The exclusion provided under subparagraph (ii) of this paragraph applies only when the physician or other licensed or certified person is rendering care to a member or subscriber of the health maintenance organization on a salaried or capitated system basis.(3) "Third party payor" means any person that administers or provides reimbursement for health care benefits on an expense incurred basis including:(i) A health maintenance organization issued a certificate of authority in accordance with Title 19, Subtitle 7 of the Health - General Article;(ii) A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or(iii) A third party administrator registered under the Insurance Article.(4) "Uniform claims form" means the claim or billing form for reimbursement of services rendered by a health care practitioner adopted by the Insurance Commissioner under § 15-1003 of the Insurance Article.(b) When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form.(c) The uniform claims form submitted under this section:(1) Shall be properly completed; and(2) May be submitted by electronic transfer.(d) The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section.Amended by 2015 Md. Laws, Ch. 22,Sec. 1, eff. 4/14/2015.