1. AS ADOPTED BY THE AMERICAN MEDICAL ASSOCIATION
FOR MEDICAL SERVICES; OR

2. AS ADOPTED BY THE AMERICAN DENTAL ASSOCIATION
FOR DENTAL SERVICES;

(II) OTHER APPLICABLE CODES UNDER A UNIFORM CODING
SCHEME REQUIRED BY THE CARRIER IN EFFECT ON THE DATE THE SERVICE OR
GROUP OF SERVICES WERE RENDERED, IN INSTANCES WHERE A CURRENT
PROCEDURAL TERMINOLOGY (CRT) CODE IS NOT THE APPLICABLE CODE FOR THE
SERVICE PROVIDED; OR

(III) THE PROVISIONS OF THE HEALTH CARE PROVIDER'S CONTRACT
WITH THE CARRIER IN EFFECT ON THE DATE THE SERVICE OR GROUP OR SERVICES
WERE RENDERED.

(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
reimbursement or attempt in any manner to retroactively collect reimbursement
already paid to a health care provider by reducing reimbursements currently owed to
the health care provider, withholding future reimbursement, or in any other manner
affecting the future reimbursement to the health care provider.

(d) (1) The provisions of subsection (b)(1) of this section do not apply if

(I) a carrier retroactively denies reimbursement to a health care
provider because OF IMPROPER CODING OR the information submitted to the carrier
was fraudulent or improperly coded OR IMPROPERLY CODED; AND

(II) IN THE CASE OF IMPROPER CODING, THE CARRIER HAS
PROVIDED TO THE HEALTH CARE PROVIDER SUFFICIENT INFORMATION REGARDING