clear space clear space clear space white space
A
 r c h i v e s   o f   M a r y l a n d   O n l i n e
  Maryland State Archives | Index | Help | Search search for:
clear space
white space
Session Laws, 2000
Volume 797, Page 4388   View pdf image
 Jump to  
  << PREVIOUS  NEXT >>
clear space clear space clear space white space
H.B. 305 VETOES
(5) "Health care provider" means a person or entity licensed, certified or
otherwise authorized under the Health Occupations Article or the Health - General
Article to provide health care services. (6) "REIMBURSEMENT" MEANS PAYMENTS MADE TO A HEALTH CARE
PROVIDER BY A CARRIER ON EITHER A FEE-FOR-SERVICE, CAPITATED, OR PREMIUM
BASIS. (B) THIS SECTION DOES NOT APPLY TO AN ADJUSTMENT TO
REIMBURSEMENT MADE AS PART OF AN ANNUAL CONTRACTED RECONCILIATION OF
A RISK SHARING ARRANGEMENT UNDER AN ADMINISTRATIVE SERVICE PROVIDER
CONTRACT.
(b) (C) (1) If a carrier retroactively denies reimbursement to a health care
provider, the carrier: (i) may only retroactively deny reimbursement for services subject
to coordination of benefits with another carrier, the Maryland Medical Assistance
Program, or the Medicare Program during the 18-month period after the date that
the carrier paid the claim submitted by the health care provider; and (ii) except as provided in item (i) of this paragraph, may only
retroactively deny reimbursement during the 6-month period after the date that the
carrier paid the claim submitted by the health care provider. (2) (i) A carrier that retroactively denies reimbursement to a health
care provider under paragraph (1) of this subsection shall provide the health care
provider with a written statement specifying the basis for the retroactive denial. (ii) If the retroactive denial of reimbursement results from
coordination of benefits, the written statement shall provide the name and address of
the entity acknowledging responsibility for payment of the denied claim. (e) (D) Except as provided in subsection (d) (E) of this section, a carrier that
does not comply with the provisions of subsection (b) (C) of this section may not
retroactively deny reimbursement or attempt in any manner to retroactively collect
reimbursement already paid to a health care provider [by reducing reimbursements
currently owed to the health care provider, withholding future reimbursement, or in
any other manner affecting the future reimbursement to the health care provider]. (d) (E) (1) The provisions of subsection (b)(1) (C)(1) of this section do not
apply if A CARRIER RETROACTIVELY DENIES REIMBURSEMENT TO A HEALTH CARE
PROVIDER BECAUSE;
(i) a carrier retroactively denies reimbursement to a health-care
provider because
the information submitted to the carrier was fraudulent or
improperly coded; and (ii) in the case of improper coding, THE INFORMATION SUBMITTED
TO THE CARRIER WAS IMPROPERLY CODED AND
the carrier has provided to the
- 4388 -


 
clear space
clear space
white space

Please view image to verify text. To report an error, please contact us.
Session Laws, 2000
Volume 797, Page 4388   View pdf image
 Jump to  
  << PREVIOUS  NEXT >>


This web site is presented for reference purposes under the doctrine of fair use. When this material is used, in whole or in part, proper citation and credit must be attributed to the Maryland State Archives. PLEASE NOTE: The site may contain material from other sources which may be under copyright. Rights assessment, and full originating source citation, is the responsibility of the user.


Tell Us What You Think About the Maryland State Archives Website!



An Archives of Maryland electronic publication.
For information contact msa.helpdesk@maryland.gov.

©Copyright  October 11, 2023
Maryland State Archives