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Martin O'Malley, Governor
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Ch. 612
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(2) (i) "Carrier" means:
1. an insurer;
2. a nonprofit health service plan;
3. a health maintenance organization;
4. a dental plan organization; or
5. any other person that provides health benefit plans
subject to regulation by the State.
(ii) "Carrier" includes an entity that arranges a provider panel
for a carrier.
(3) "Credentialing intermediary" means a person to whom a carrier
has delegated credentialing or recredentialing authority and responsibility.
(4) "Health care provider" means an individual who is licensed,
certified, or otherwise authorized under the Health Occupations Article to provide
health care services.
(5) "Provider panel" means the providers that contract with a carrier
to provide health care services to the enrollees under a health benefit plan of the
carrier.
(6) "Uniform credentialing form" means the form designated by the
Commissioner through regulation for use by a carrier or its credentialing intermediary
for credentialing and recredentialing a health care provider for participation on a
provider panel.
(b) (1) [A] EXCEPT AS PROVIDED IN SUBSECTION (C) OF THIS
SECTION, A carrier or its credentialing intermediary shall accept the uniform
credentialing form as the sole application for a health care provider to become
credentialed or recredentialed for a provider panel of the carrier.
(2) A carrier or its credentialing intermediary shall make the uniform
credentialing form available to any health care provider that is to be credentialed or
recredentialed by that carrier or credentialing intermediary.
(C) THE REQUIREMENTS OF SUBSECTION (B) OF THIS SECTION DO NOT
APPLY TO A HOSPITAL OR ACADEMIC MEDICAL CENTER THAT:
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- 3897 -
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