(i) an insurer;

(ii) a nonprofit health service plan;

(iii) a health maintenance organization;

(iv) a dental plan organization; or

(v) any other person that provides health benefit plans subject to
regulation by the State.

(3) " CODE" MEANS:

(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.

(41 "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.

(4) "IMPROPER CODING" MEANS THE INACCURATE OR INAPPROPRIATE
DESCRIPTION OF A SERVICE OR GROUP OF SERVICES BY A HEALTH CARE PROVIDER
FOR PAYMENT BY A CARRIER THAT USES PROCEDURAL CODES FOR THE SERVICE OR
GROUP OF SERVICES DELIVERED, WHERE THE DESCRIPTION DOES NOT CONFORM
WITH:

(I) THE APPLICABLE CURRENT PROCEDURAL TERMINOLOGY (CPT)
CODE IN EFFECT ON THE DATE THE SERVICE OR GROUP OF SERVICES WERE
RENDERED: