PARRIS N. GLENDENING, Governor

Ch. 35

Also in subsection (c) of this section, the former references to a "hospital" are
deleted as included in the defined term "person".

Defined terms: "Health insurance" § 1-101
"Insurer" § 1-101
"Person" § 1-101
"Policy" § 1-101

15-1002. CLAIM FORMS TO CONFORM TO REGULATIONS.

TO PROVIDE A STANDARD SYSTEM OF PAYMENT FOR MEDICAL SERVICES,
EACH CLAIM FORM FOR USE UNDER AN INDIVIDUAL OR GROUP HEALTH
INSURANCE POLICY THAT IS ISSUED OR DELIVERED IN THE STATE SHALL CONFORM
TO A FORM OR REGULATIONS THAT THE COMMISSIONER ADOPTS.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 438B.

The reference to "regulations" is substituted for the former reference to
"rules". See the General Revisor's Note to this article.

The former reference to claim forms for "any claimant's" use is deleted as
implicit.

Defined terms: "Commissioner" § 1-101
"Health insurance" § 1-101
"Policy" § 1-101

15-1003. ADOPTION OF UNIFORM CLAIMS FORMS REQUIRED.

(A) DEFINITIONS.

(1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.

(2) (I) "HEALTH CARE PRACTITIONER" MEANS A PERSON THAT IS
LICENSED OR CERTIFIED UNDER THE HEALTH OCCUPATIONS ARTICLE AND
REIMBURSED BY A THIRD PARTY PAYOR.

(II) "HEALTH CARE PRACTITIONER" DOES NOT INCLUDE A
PHYSICIAN OR OTHER PERSON LICENSED OR CERTIFIED UNDER THIS ARTICLE
WHEN THE PHYSICIAN OR OTHER PERSON IS RENDERING CARE TO A MEMBER OR
SUBSCRIBER OF A HEALTH MAINTENANCE ORGANIZATION AND IS COMPENSATED
BY THE HEALTH MAINTENANCE ORGANIZATION FOR THAT CARE ON A SALARIED
OR CAPITATED BASIS.

(3) "HOSPITAL" HAS THE MEANING STATED IN § 19-301 OF THE HEALTH -
GENERAL ARTICLE.

(B) HOSPITAL SERVICES.

THE COMMISSIONER SHALL ADOPT BY REGULATION AS THE UNIFORM CLAIMS
FORM FOR REIMBURSEMENT OF HOSPITAL SERVICES IN THE STATE THE UNIFORM
CLAIMS FORM ADOPTED BY THE NATIONAL UNIFORM BILLING COMMITTEE AND

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