(a)(1) In this section the following words have the meanings indicated.
(2)(i) “Carrier” means:
1. an insurer;
2. a nonprofit health service plan;
3. a health maintenance organization;
4. a dental plan organization;
5. a managed care organization; or
6. any other person that provides health benefit plans subject to regulation by the State.
(ii) “Carrier” includes an entity that arranges a provider panel for a carrier.
(3) “Credentialing intermediary” means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.
(4) “Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.
(5) “Provider panel” means the providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.
(6) “Uniform credentialing form” means the form designated by the Commissioner for use by a carrier or its credentialing intermediary for credentialing and recredentialing a health care provider for participation on a provider panel.
Uniform credentialing form as the sole application for health care provider to become credentialed for provider panel
(b)(1) Except as provided in subsection (c) of this section, a carrier or its credentialing intermediary shall accept the uniform credentialing form as the sole application for a health care provider to become credentialed or recredentialed for a provider panel of the carrier.
(2) A carrier or its credentialing intermediary shall make the uniform credentialing form available to any health care provider that is to be credentialed or recredentialed by that carrier or credentialing intermediary.
Hospitals or academic medical centers exempt from requirement
(c) The requirements of subsection (b) of this section do not apply to a hospital or academic medical center that:
(1) is a participating provider on the carrier's provider panel; and
(2) acts as a credentialing intermediary for that carrier for health care practitioners that:
(i) participate on the carrier's provider panel; and
(ii) have privileges at the hospital or academic medical center.
Penalties for violation of section
(d) The Commissioner may impose a penalty not to exceed $500 against any carrier for each violation of this section by the carrier or its credentialing intermediary.
Regulations
(e)(1) The Commissioner may adopt regulations to implement the provisions of this section.
(2) The Commissioner may designate a provider credentialing application developed by a nonprofit alliance of health plans and trade associations for an online credentialing system offered to carriers and providers as the uniform credentialing form if:
(i) the provider credentialing application is available to providers at no charge; and
(ii) use of the provider credentialing application is not conditioned on submitting the provider credentialing application to a carrier through the online credentialing system.
Credits
Added by Acts 1999, c. 589, § 1, eff. Jan. 1, 2000. Amended by Acts 2007, c. 612, § 1, eff. June 1, 2007; Acts 2009, c. 90, § 1, eff. Oct. 1, 2009; Acts 2009, c. 91, § 1, eff. Oct. 1, 2009.
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.
