Section 1-208 - Uniform claims forms. - Maryland Statutes

§ 1-208. Uniform claims forms.
 

(a)  Definitions.-  

(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 only applies 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)  Use required.- When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form. 

(c)  Completion; transfer.- The uniform claims form submitted under this section: 

(1) Shall be properly completed; and 

(2) May be submitted by electronic transfer. 

(d)  Penalty.- The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section. 
 

[1992, ch. 613; 1994, ch. 3, § 1; 1995, ch. 3, § 1; 1997, ch. 70, § 4.]