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2000 LAWS OF MARYLAND
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Ch. 355
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(F) (B) IF A COURSE OF TREATMENT HEALTH CARE SERVICE FOR A PATIENT
HAS BEEN PREAUTHORIZED OR APPROVED BY A CARRIER OR THE CARRIER'S
PRIVATE REVIEW AGENT, THE CARRIER MAY NOT DENY REIMBURSEMENT TO A
HEALTH CARE PROVIDER FOR THE PREAUTHORIZED OR APPROVED SERVICES
SERVICE DELIVERED TO THAT PATIENT UNLESS:
(1) THE INFORMATION SUBMITTED TO THE CARRIER REGARDING THE
SERVICES SERVICE TO BE DELIVERED TO THE PATIENT WAS FRAUDULENT OR
INTENTIONALLY MISREPRESENTATIVE OR;
(2) CRITICAL INFORMATION REQUESTED BY THE CARRIER REGARDING
SERVICES THE SERVICE TO BE DELIVERED TO THE PATIENT WAS OMITTED SUCH
THAT THE CARRIER'S DETERMINATION WOULD HAVE BEEN DIFFERENT HAD IT
KNOWN THE CRITICAL INFORMATION; OR
(2) (3) THE A PLANNED COURSE OF TREATMENT FOR THE PATIENT
THAT WAS APPROVED BY THE CARRIER WAS NOT SUBSTANTIALLY FOLLOWED BY
THE HEALTH CARE PROVIDER; OR
(4) ON THE DATE THE PREAUTHORIZED OR APPROVED SERVICE WAS
DELIVERED:
(I) THE PATIENT WAS NOT COVERED BY THE CARRIER;
(II) THE CARRIER MAINTAINED AN AUTOMATED ELIGIBILITY
VERIFICATION SYSTEM THAT WAS AVAILABLE TO THE CONTRACTING PROVIDER BY
TELEPHONE OR VIA THE INTERNET; AND
(III) ACCORDING TO THE VERIFICATION SYSTEM, THE PATIENT WAS
NOT COVERED BY THE CARRIER.
(C) A CARRIER SHALL PAY A CLAIM FOR A PREAUTHORIZED OR APPROVED
COVERED HEALTH CARE SERVICE IN ACCORDANCE WITH §§ 15-1005 AND 15-1008 OF
THIS SUBTITLE.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act applies to
reimbursements for health care services that are preauthorized or approved on or
after June 1, 2000.
SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take
effect October June 1, 2000.
Approved May 11, 2000.
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- 2042 -
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