§ 15-1004. Acceptance of uniform claims forms and attachments
West's Annotated Code of MarylandInsuranceEffective: October 1, 2016
Effective: October 1, 2016
MD Code, Insurance, § 15-1004
§ 15-1004. Acceptance of uniform claims forms and attachments
(a) For services rendered by a person entitled to reimbursement under § 15-701(a) of this title or by a hospital, as defined in § 19-301 of the Health-General Article, an insurer, nonprofit health service plan, or health maintenance organization:
(b)(1) A uniform claims form submitted under this section shall be completed properly and may be submitted by electronic transfer.
(2) If the health care practitioner rendering the service is a certified registered nurse anesthetist or certified nurse midwife, the uniform claims form shall include identification modifiers for the certified registered nurse anesthetist or certified nurse midwife that indicate whether the service is provided with or without medical direction by a physician.
(c) In accordance with §§ 15-1003(d)(1)(ii) and 15-1005(c) of this subtitle, if the legitimacy or appropriateness of a health care service is disputed, an insurer, nonprofit health service plan, or health maintenance organization may request additional medical information that describes and summarizes the diagnosis, treatment, and services rendered to the insured.
(d)(1) Insurers, nonprofit health service plans, and health maintenance organizations shall provide and update, as appropriate, all contracting providers and any other provider on request, with a manual or other document that sets forth the claims filing procedures, including:
(e)(1) If necessary to determine eligibility for benefits or to determine coverage, an insurer, nonprofit health service plan, or health maintenance organization may obtain additional information from its insured, member, or subscriber, the employer of the insured, member or subscriber, or any other nonprovider third party.
Credits
Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 1999, c. 532, § 1, eff. Oct. 1, 1999; Acts 2000, c. 410, § 1, eff. June 1, 2000; Acts 2017, c. 62, § 6.
Formerly Art. 48A, §§ 354Z, 470U, 477AA.
MD Code, Insurance, § 15-1004, MD INSURANCE § 15-1004
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.
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