WILLIAM DONALD SCHAEFER, Governor

Ch. 9

(II) ANY AMOUNT FOR A DIAGNOSTIC TEST FOR WHICH PAYMENT MAY
NOT BE MADE PURSUANT TO PARAGRAPH (2) OF THIS SUBSECTION.

(H) THE COMMISSION, IN CONSULTATION WITH THE INSURANCE COMMISSIONER,
PAYORS, HEALTH CARE PRACTITIONERS, AND HOSPITALS, MAY ADOPT BY REGULATION
STANDARDS FOR THE ELECTRONIC SUBMISSION OF DATA AND SUBMISSION AND
TRANSFER OF THE UNIFORM CLAIMS FORMS ESTABLISHED UNDER ARTICLE 48A, § 490P
OF THE CODE.

19-1508.

(A) THE COMMISSION, IN CONSULTATION WITH INTERESTED PARTIES
INCLUDING PAYORS, THE MEDICAL AND CHIRURGICAL FACULTY OF MARYLAND,
THE MARYLAND PHARMACISTS ASSOCIATION PHYSICIANS, PHARMACISTS, THE
MARYLAND HOSPITAL ASSOCIATION, AND ANY OTHER HEALTH CARE
PRACTITIONERS AS APPROPRIATE, SHALL DEVELOP A SYSTEM TO FOSTER THE
DEVELOPMENT OF PRACTICE PROTOCOLS AND TO PROVIDE INFORMATION TO
PHYSICIANS CONCERNING THEIR CHARGES AND UTILIZATION OF SERVICES IN
COMPARISON TO THEIR PEERS.

(B) THE COMMISSION MAY LIMIT THE DEVELOPMENT AND DISTRIBUTION OF
COMPARATIVE INFORMATION TO PHYSICIANS REQUIRED UNDER SUBSECTION (A)
OF THIS SECTION TO:

(1) PHYSICIANS WHOSE CHARGES FOR OR UTILIZATION OF HEALTH
CARE SERVICES ARE CONSIDERED OUTLIERS; OR

(2) PHYSICIANS WHO RENDER CERTAIN HEALTH CARE SERVICES
SELECTED BY THE COMMISSION.

(A) (1) IN ORDER TO MORE EFFICIENTLY ESTABLISH A MEDICAL CARE DATA
BASE UNDER § 19-1507 OF THIS SUBTITLE, THE COMMISSION SHALL ESTABLISH
STANDARDS FOR THE OPERATION OF ONE OR MORE MEDICAL CARE ELECTRONIC
CLAIMS CLEARINGHOUSES IN MARYLAND AND MAY LICENSE THOSE CLEARINGHOUSES
MEETING THOSE STANDARDS.

(2) IN ADOPTING REGULATIONS UNDER THIS SUBSECTION, THE
COMMISSION SHALL CONSIDER APPROPRIATE NATIONAL STANDARDS.

(3) THE COMMISSION MAY LIMIT THE NUMBER OF LICENSED CLAIMS
CLEARINGHOUSES TO ASSURE MAXIMUM EFFICIENCY AND COST EFFECTIVENESS.

(4) THE COMMISSION, BY REGULATION, MAY CHARGE A REASONABLE
LICENSING FEE TO OPERATE A LICENSED CLAIMS CLEARINGHOUSE.

(5) ON OR BEFORE JULY 1, 1995, HEALTH CARE PRACTITIONERS IN
MARYLAND, AS DESIGNATED BY THE COMMISSION, SHALL SUBMIT, AND PAYORS OF
HEALTH CARE SERVICES IN MARYLAND AS DESIGNATED BY THE COMMISSION SHALL
RECEIVE CLAIMS FOR PAYMENT AND ANY OTHER INFORMATION REASONABLY RELATED
TO THE MEDICAL CARE DATA BASE ELECTRONICALLY IN A STANDARD FORMAT AS
REQUIRED BY THE COMMISSION WHETHER BY MEANS OF A CLAIMS CLEARINGHOUSE OR
OTHER METHOD APPROVED BY THE COMMISSION.

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