The purpose of this subtitle is to:
(1) promote the delivery of quality health care in a cost effective manner;
(2) foster greater coordination between payors and providers conducting utilization review activities;
(3) protect patients, business, and providers by ensuring that private review agents are qualified to perform utilization review activities and to make informed decisions on the appropriateness of medical care; and
(4) ensure that private review agents maintain the confidentiality of medical records in accordance with applicable State and federal laws.
Structure Maryland Statutes
Subtitle 10B - Private Review Agents
Section 15-10B-01 - Definitions
Section 15-10B-02 - Purpose of Subtitle
Section 15-10B-04 - Certificates -- Application; Fees
Section 15-10B-05 - Certificates -- Additional Information
Section 15-10B-06 - Determinations by Private Review Agent
Section 15-10B-07 - Adverse Decisions by Private Review Agent
Section 15-10B-08 - Requirements of Internal Grievance Process
Section 15-10B-09 - Requirements of Internal Grievance Process -- Maternity and Newborn Care
Section 15-10B-09.1 - Requirements of Grievance Decision
Section 15-10B-10 - Certificates -- Expiration; Renewal
Section 15-10B-11 - Private Review Agent -- Prohibitions
Section 15-10B-12 - Private Review Agent -- Penalties
Section 15-10B-13 - Right to Hearing and Appeal From Action of Commissioner
Section 15-10B-14 - Waiver of Requirements for Review of Certain Patients
Section 15-10B-15 - List of Private Review Agents
Section 15-10B-16 - Reporting Requirements
Section 15-10B-17 - Patient Referrals by Private Review Agents
Section 15-10B-18 - Withdrawal and Submission of Certificate
Section 15-10B-19 - Examination by Commissioner
Section 15-10B-20 - Examination by Commissioner -- Pharmacy Benefit Manager