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PARRIS N. GLENDENING, Governor H.B. 305
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civil action; providing that certain provisions of law related to the retroactive
denial of reimbursement to a health care provider do not apply to adjustments to
reimbursements made as part of an annual contracted reconciliation of a risk
sharing arrangement under an administrative service provider contract; defining
a certain term; providing for the application of this Act; providing for the
application of this Act; and generally relating to retroactive denial of
reimbursement to health care providers by carriers under health insurance.
BY repealing and reenacting, with amendments,
Article - Insurance
Section 15-1008
Annotated Code of Maryland
(1997 Volume and 1999 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Insurance
15-1008.
(a) (1) In this section the following words have the meanings indicated.
(2) "Carrier" means:
(i) an insurer;
(ii) a nonprofit health service plan;
(iii) a health maintenance organization;
(iv) a dental plan organization; or
(v) any other person that provides health benefit plans subject to
regulation by the State.
(3) "Code" means:
(i) the applicable current procedural terminology (CPT) code, as
adopted by the American Medical Association;
(ii) if for a dental service, the applicable code adopted by the
American Dental Association; or
(iii) another applicable code under an appropriate uniform coding
scheme used by a carrier in accordance with this section.
(4) "Coding guidelines" means those standards or procedures used or
applied by a payor to determine the most accurate and appropriate code or codes for
payment by the payor for a service or services.
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- 4387 -
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