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ROBERT L. EHRLICH, JR., Governor
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Ch. 276
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THE PROVIDER'S CLAIM AUTOMATICALLY, WITHOUT THE NECESSITY FOR THE
PROVIDER TO RESUBMIT THE CLAIM, AND WITHOUT REGARD TO TIMELY
SUBMISSION DEADLINES.
(e) (1) If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(i) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall mail or
otherwise transmit payment for any undisputed portion of the claim within 30 days of
receipt of the claim, in accordance with this section.
(2) If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(ii) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall:
(i) mail or otherwise transmit payment for any undisputed portion
of the claim in accordance with this section; and
(ii) comply with subsection (c)(1) or (2)(i) of this section within 30
days after receipt of the requested additional information.
(3) If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(iii) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall comply with
subsection (c)(1) or (2)(i) of this section within 30 days after receipt of the requested
additional information.
(f) (1) If an insurer, nonprofit health service plan, or health maintenance
organization fails to comply with subsection (c) of this section, the insurer, nonprofit
health service plan, or health maintenance organization shall pay interest on the
amount of the claim that remains unpaid 30 days after the claim is received at the
monthly rate of:
(i) 1.5% from the 31st day through the 60th day;
(ii) 2% from the 61st day through the 120th day; and
(iii) 2.5% after the 120th day.
(2) The interest paid under this subsection shall be included in any late
reimbursement without the necessity for the person that filed the original claim to
make an additional claim for that interest.
(g) An insurer, nonprofit health service plan, or health maintenance
organization that violates a provision of this section is subject to:
(1) a fine not exceeding $500 for each violation that is arbitrary and
capricious, based on all available information; and
(2) the penalties prescribed under § 4-113(d) of this article for violations
committed with a frequency that indicates a general business practice.
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- 1371 -
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