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PARRIS N. GLENDENING, Governor Ch. 323
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(ii) The contracting provider administer payments pursuant to the
contract within WITH the health maintenance organization for the health care
services to the external providers.
(3) "Contracting provider" means a physician or other health care
provider PERSON who enters into an administrative service provider contract with a
health maintenance organization.
(4) "External provider" means a health care provider PERSON HEALTH
CARE PROVIDER, including a physician or hospital, who is not:
(i) A contracting provider; or
(ii) An employee, shareholder, or partner of a contracting provider.
(B) THIS SECTION DOES NOT APPLY TO A CONTRACT BETWEEN A HEALTH
MAINTENANCE ORGANIZATION AND A CONTRACTING PROVIDER THAT IS
AFFILIATED WITH THE HEALTH MAINTENANCE ORGANIZATION THROUGH COMMON
OWNERSHIP WITHIN AN INSURANCE HOLDING COMPANY SYSTEM, IF THE HEALTH
MAINTENANCE ORGANIZATION:
(1) FILES WITH THE COMMISSIONER CONSOLIDATED FINANCIAL
STATEMENTS THAT INCLUDE THE CONTRACTING PROVIDER; AND
(2) RECORDS A RESERVE FOR THE LIABILITIES OF THE CONTRACTING
PROVIDER IN ACCORDANCE WITH § 5-201 OF THIS ARTICLE.
(b) (C) A health maintenance organization may not enter into an
administrative service provider contract unless:
(1) The health maintenance organization files with the Insurance
Commissioner a plan that satisfies the requirements of subsection (e) (D) of this
section; and
(2) The Insurance Commissioner does not disapprove the filing within 30
days after the plan is filed.
(e) (D) The plan required under subsection (b) (C) of this section shall:
(1) Require the contracting provider to provide the health maintenance
organization with regular MONTHLY reports, at least quarterly WITHIN 30 DAYS OF
THE END OF THE MONTH REPORTED, that identify payments made or owed to
external providers in sufficient detail to determine if the payments are being made in
compliance with law;
(2) Require the contracting provider to provide to the health
maintenance organization a current, AUDITED annual financial statement of the
contracting provider each year, WITHIN 90 DAYS OF THE END OF THE YEAR
REPORTED;
(3) Require the creation by the contracting provider, or on the
contracting provider's behalf, of HEALTH MAINTENANCE ORGANIZATION TO
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