Maryland Statutes
Subtitle 2 - General Provisions
Section 1-208 - Uniform Claims Forms

(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.

Structure Maryland Statutes