Ch. 480 LAWS OF MARYLAND

TREATING THE PATIENT OR RECIPIENT ON WHOM THE MEDICAL
RECORD IS KEPT;

(5) IF A CLAIM HAS BEEN OR MAY BE FILED BY, OR WITH THE
AUTHORIZATION OF A PATIENT OR RECIPIENT ON BEHALF OF THE
PATIENT OR RECIPIENT, FOR COVERED INSUREDS, COVERED
BENEFICIARIES, OR ENROLLED RECIPIENTS ONLY, TO THIRD PARTY
PAYORS AND THEIR AGENTS, IF THE PAYORS OR AGENTS HAVE MET THE
APPLICABLE PROVISIONS OF TITLE 19, SUBTITLE 13 OF THE HEALTH -
GENERAL ARTICLE, INCLUDING NONPROFIT HEALTH SERVICE PLANS,
HEALTH MAINTENANCE ORGANIZATIONS, FISCAL INTERMEDIARIES
AND CARRIERS, THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE
AND ITS AGENTS, THE UNITED STATES DEPARTMENT OF HEALTH AND
HUMAN SERVICES AND ITS AGENTS, OR ANY OTHER PERSON OBLIGATED
BY CONTRACT OR LAW TO PAY FOR THE HEALTH CARE RENDERED FOR
THE SOLE PURPOSES OF:

(I) SUBMITTING A BILL TO THE THIRD PARTY PAYOR;

(II) REASONABLE PROSPECTIVE, CONCURRENT, OR
RETROSPECTIVE UTILIZATION REVIEW OR PREDETERMINATION OF
BENEFIT COVERAGE;

(III) REVIEW, AUDIT, AND INVESTIGATION OF A SPECIFIC
CLAIM FOR PAYMENT OF BENEFITS; OR

(IV) COORDINATING BENEFIT PAYMENTS IN ACCORDANCE
WITH THE PROVISIONS OF ARTICLE 48A OF THE CODE UNDER MORE
THAN 1 SICKNESS AND ACCIDENT, DENTAL, OR HOSPITAL AND MEDICAL
INSURANCE POLICY;

(6) IF A HEALTH CARE PROVIDER MAKES A PROFESSIONAL
DETERMINATION THAT AN IMMEDIATE DISCLOSURE IS NECESSARY, TO
PROVIDE FOR THE EMERGENCY HEALTH CARE NEEDS OF A PATIENT OR
RECIPIENT;

(7) EXCEPT IF THE PATIENT HAS INSTRUCTED THE HEALTH
CARE PROVIDER NOT TO MAKE THE DISCLOSURE, OR IF THE RECORD
HAS BEEN DEVELOPED PRIMARILY IN CONNECTION WITH THE
PROVISION OF MENTAL HEALTH SERVICES, TO IMMEDIATE FAMILY
MEMBERS OF THE PATIENT OR ANY OTHER INDIVIDUAL WITH WHOM
THE PATIENT IS KNOWN TO HAVE A CLOSE PERSONAL RELATIONSHIP, IF
MADE IN ACCORDANCE WITH GOOD MEDICAL OR OTHER
PROFESSIONAL PRACTICE; OR OR

(8) TO ORGAN AND TISSUE PROCUREMENT PERSONNEL
UNDER THE RESTRICTIONS OF § 5-408 OF THIS ARTICLE AT THE REQUEST
OF A PHYSICIAN FOR A PATIENT WHOSE ORGANS AND TISSUES MAY BE
DONATED FOR THE PURPOSE OF EVALUATING THE PATIENT FOR
POSSIBLE ORGAN AND TISSUE DONATIONT^-QR

- 2036 -