(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.
Claim or bill for reimbursement
(b) When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form.
Submitted claims
(c) The uniform claims form submitted under this section:
(1) Shall be properly completed; and
(2) May be submitted by electronic transfer.
Fines and penalties
(d) The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section.
Credits
Added by Acts 1992, c. 613, § 1, eff. Oct. 1, 1992. Amended by Acts 1994, c. 3, § 1, eff. Feb. 28, 1994; Acts 1995, c. 3, § 1, eff. March 7, 1995; Acts 1997, c. 70, § 4, eff. Oct. 1, 1997; Acts 2015, c. 22, § 1, eff. April 14, 2015.
MD Code, Health Occupations, § 1-208, MD HEALTH OCCUP § 1-208
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
