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Current as of January 01, 2025 | Updated by Findlaw Staff
(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.
Cite this article: FindLaw.com - Maryland Code, Health Occupations § 1-208 - last updated January 01, 2025 | https://codes.findlaw.com/md/health-occupations/md-code-health-occup-sect-1-208/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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