Ch. 35

1997 LAWS OF MARYLAND

APPROVED BY THE HEALTH CARE FINANCING ADMINISTRATION FOR HOSPITAL
PAYMENTS UNDER TITLE XVIII OF THE SOCIAL SECURITY ACT.

(C) HEALTH CARE PRACTITIONERS' SERVICES.

THE COMMISSIONER SHALL ADOPT BY REGULATION A UNIFORM CLAIMS FORM
FOR REIMBURSEMENT OF HEALTH CARE PRACTITIONERS' SERVICES.

REVISOR'S NOTE: This section is new language derived without substantive
change from former Art. 48A, § 490P.

Defined terms: "Commissioner" § 1-101
"Person" § 1-101

15-1004. ACCEPTANCE OF UNIFORM CLAIMS FORMS REQUIRED.

(A) IN GENERAL.

FOR SERVICES RENDERED BY A PERSON ENTITLED TO REIMBURSEMENT
UNDER § 15-701(A) OF THIS TITLE OR BY A HOSPITAL, AS DEFINED IN § 19-301 OF THE
HEALTH - GENERAL ARTICLE, AN INSURER OR NONPROFIT HEALTH SERVICE PLAN:

(1) EXCEPT AS PROVIDED IN SUBSECTION (C) OF THIS SECTION, SHALL
ACCEPT THE UNIFORM CLAIMS FORM ADOPTED BY THE COMMISSIONER UNDER §
15-1003 OF THIS SUBTITLE:

(I) AS A PROPERLY FILED CLAIM WITH ALL NECESSARY
DOCUMENTATION; AND

(II) AS THE SOLE INSTRUMENT FOR REIMBURSEMENT; AND

(2) MAY NOT IMPOSE AS A CONDITION OF REIMBURSEMENT A
REQUIREMENT TO:

(I) MODIFY THE UNIFORM CLAIMS FORM OR ITS CONTENT; OR

(II) SUBMIT ADDITIONAL CLAIMS FORMS.

(B) COMPLETION AND SUBMISSION OF FORMS.

A UNIFORM CLAIMS FORM SUBMITTED UNDER THIS SECTION SHALL BE
COMPLETED PROPERLY AND MAY BE SUBMITTED BY ELECTRONIC TRANSFER.

(C) ADDITIONAL MEDICAL INFORMATION FOR DISPUTED CLAIMS.

IF THE LEGITIMACY OR APPROPRIATENESS OF A HEALTH CARE SERVICE IS
DISPUTED, AN INSURER OR NONPROFIT HEALTH SERVICE PLAN MAY REQUEST
ADDITIONAL MEDICAL INFORMATION THAT DESCRIBES AND SUMMARIZES THE
DIAGNOSIS, TREATMENT, AND SERVICES RENDERED TO THE INSURED.

(D) ADDITIONAL INFORMATION TO DETERMINE ELIGIBILITY OR COVERAGE.

(1) IF NECESSARY TO DETERMINE ELIGIBILITY FOR BENEFITS OR TO
DETERMINE COVERAGE, AN INSURER OR NONPROFIT HEALTH SERVICE PLAN MAY

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