PARRIS N. GLENDENING, Governor                             Ch. 590

(D) A HEALTH MAINTENANCE ORGANIZATION SHALL PERMIT A PROVIDER A
MINIMUM OF 6 MONTHS FROM THE DATE A COVERED SERVICE IS RENDERED TO
SUBMIT A CLAIM FOR REIMBURSEMENT FOR THE SERVICE.

(E) (1) IF A HEALTH MAINTENANCE ORGANIZATION NOTIFIES A PROVIDER
THAT ADDITIONAL DOCUMENTATION IS NECESSARY TO ADJUDICATE A CLAIM, THE
HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE THE PROVIDER FOR
COVERED SERVICES WITHIN 30 DAYS AFTER RECEIPT OF ALL REASONABLE AND
NECESSARY DOCUMENTATION.

(2) IF A HEALTH MAINTENANCE ORGANIZATION FAILS TO COMPLY
WITH THE REQUIREMENTS OF PARAGRAPH (1) OF THIS SUBSECTION. THE HEALTH
MAINTENANCE ORGANIZATION SHALL PAY INTEREST IN ACCORDANCE WITH THE
REQUIREMENTS OF SUBSECTION (B) OF THIS SECTION.

Article - Insurance

15-1005.

(a)     This section does not apply when there is a good faith dispute about the
legitimacy of a claim or the appropriate amount of reimbursement.

(b)     To the extent consistent with the Employee Retirement Income Security Act
of 1974 (ERISA), 29 U.S.C. 1001, et seq., this section applies to an insurer or nonprofit
health service plan that, acts as a third party administrator.

(c)     Within 30 days after receipt of a claim for reimbursement from a person
entitled to reimbursement under § 15-701(a) of this title or from a hospital or related
institution, as those terms are defined in § 19-301 of the Health - General Article, an
insurer or nonprofit health service plan shall:

(1)     pay the claim in accordance with this section; or

(2)     send a notice of receipt and status of the claim that states:

(i) that the insurer or nonprofit health service plan refuses to
reimburse all or part of the claim and the reason for the refusal; or

(ii) that additional information is necessary to determine if all or part
of the claim will be reimbursed and what specific additional information is necessary.

(D) IF AN INSURER OR NONPROFIT HEALTH SERVICE PLAN SENDS NOTICE
UNDER SUBSECTION (C)(2) OF THIS SECTION, OR NOTIFIES THE PERSON THAT FILED
A CLAIM THAT THE CLAIM WAS NOT RECEIVED, ANY TIME LIMIT IMPOSED BY THE
INSURER OR NONPROFIT HEALTH SERVICE PLAN FOR SUBMITTING CLAIM
INFORMATION SHALL BEGIN ON THE DATE THE NOTICE IS GIVEN.

(D) AN INSURER OR A NONPROFIT HEALTH SERVICE PLAN SHALL PERMIT A
PROVIDER A MINIMUM OF 6 MONTHS FROM THE DATE A COVERED SERVICE IS
RENDERED TO SUBMIT A CLAIM FOR REIMBURSEMENT FOR THE SERVICE.

(E) (1) IF AN INSURER OR NONPROFIT HEALTH SERVICE PLAN NOTIFIES A
PROVIDER THAT ADDITIONAL DOCUMENTATION IS NECESSARY TO ADJUDICATE A

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