(I) THE APPLICABLE CURRENT PROCEDURAL TERMINOLOGY (CPT)
CODE, AS ADOPTED BY THE AMERICAN MEDICAL ASSOCIATION;

(II) IF FOR A DENTAL SERVICE, THE APPLICABLE CODE ADOPTED
BY THE AMERICAN DENTAL ASSOCIATION; OR

(III) ANOTHER APPLICABLE CODE UNDER AN APPROPRIATE
UNIFORM CODING SCHEME USED BY A CARRIER IN ACCORDANCE WITH THIS
SECTION.

(4) "CODING GUIDELINES" MEANS THOSE STANDARDS OR PROCEDURES
USED OR APPLIED BY A PAYOR TO DETERMINE THE MOST ACCURATE AND
APPROPRIATE CODE OR CODES FOR PAYMENT BY THE PAYOR FOR A SERVICE OR
SERVICES.

(3) (5) "Health care provider" means a person or entity licensed,
certified or otherwise authorized under the Health Occupations Article or the Health
- General Article to provide health care services.

(4) "IMPROPER CODING" MEANS THE USE OF A PROCEDURAL CODE FOR
A PROCEDURE OR SERVICE DELIVERED, IN A SUBMISSION OF CLAIM INFORMATION,
THAT DOES NOT CONFORM WITH

(I) THE VERSION OF THE AMERICAN MEDICAL ASSOCIATION'S
CLINICAL PROCEDURAL TERMINOLOGY CODE BOOK IN EFFECT ON THE DATE A
CLAIM WAS SUBMITTED TO A CARRIER FOR REIMBURSEMENT; OR

(II) THE CODING GUIDELINES THAT A CARRIER HAS PROVIDED IN
WRITING TO THE HEALTH CARE PROVIDER THAT ARE IN EFFECT ON THE DATE THAT
THE CLAIM WAS SUBMITTED TO THE CARRIER FOR REIMBURSEMENT.

(b) (1) If a carrier retroactively denies reimbursement to a health care
provider, the carrier:

(i) may only retroactively deny reimbursement for services subject
to coordination of benefits with another carrier, the Maryland Medical Assistance
Program, or the Medicare Program during the 18-month period after the date that
the carrier paid the claim submitted by the health care provider; and

(ii) except as provided in item (i) of this paragraph, may only
retroactively deny reimbursement during the 6-month period after the date that the
carrier paid the claim submitted by the health care provider.

(2) (i) A carrier that retroactively denies reimbursement to a health
care provider under paragraph (1) of this subsection shall provide the health care
provider with a written statement specifying the basis for the retroactive denial.

(ii) If the retroactive denial of reimbursement results from
coordination of benefits, the written statement shall provide the name and address of
the entity acknowledging responsibility for payment of the denied claim.

(c) Except as provided in subsection (d) of this section, a carrier that does not
comply with the provisions of subsection (b) of this section may not retroactively deny