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Martin O'Malley, Governor
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Ch. 612
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[(6)] (7) "Provider" means a health care practitioner or group of
health care practitioners licensed, certified, or otherwise authorized by law to provide
health care services.
[(7)] (8) (i) "Provider panel" means the providers that contract
either directly or through a subcontracting entity with a carrier to provide health care
services to the carrier's enrollees under the carrier's health benefit plan.
(ii) "Provider panel" does not include an arrangement in which
any provider may participate solely by contracting with the carrier to provide health
care services at a discounted fee-for-service rate.
(d) (1) A provider that seeks to participate on a provider panel of a carrier
shall submit an application to the carrier.
(2) (i) Subject to paragraph (3) of this subsection, the carrier, after
reviewing the application, shall accept or reject the provider for participation on the
carrier's provider panel.
(ii) If the carrier rejects the provider for participation on the
carrier's provider panel, the carrier shall send to the provider at the address listed in
the application written notice of the rejection.
(3) (i) Except as provided in paragraph (4) of this subsection,
within 30 days after the date a carrier receives a completed application, the carrier
shall send to the provider at the address listed in the application written notice of:
1. the carrier's intent to continue to process the
provider's application to obtain necessary credentialing information; or
2. the carrier's rejection of the provider for participation
on the carrier's provider panel.
(ii) The failure of a carrier to provide the notice required under
subparagraph (i) of this paragraph is a violation of this article and the carrier is
subject to the penalties provided by § 4-113(d) of this article.
(iii) [If,] EXCEPT AS PROVIDED IN SUBSECTION (O) OF THIS
SECTION, IF, under subparagraph (i)l of this paragraph, a carrier provides notice to
the provider of its intent to continue to process the provider's application to obtain
necessary credentialing information, the carrier, within 120 days after the date the
notice is provided, shall:
1. accept or reject the provider for participation on the
carrier's provider panel; and
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- 3895 -
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