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PARRIS N. GLENDENING, Governor Ch. 355
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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 the information submitted to the carrier was fraudulent or
improperly coded; and
(ii) in the case of improper coding, the carrier has provided to the
health care provider sufficient information regarding the coding guidelines used by
the carrier at least 30 days prior to the date the services subject to the retroactive
denial were rendered.
(2) Information submitted to the carrier may be considered to be
improperly coded under paragraph (1) of this subsection if the information submitted
to the carrier by the health care provider:
(i) uses codes that do not conform with the coding guidelines used
by the carrier applicable as of the date the service or services were rendered; or
(ii) does not otherwise conform with the contractual obligations of
the health care provider to the carrier applicable as of the date the service or services
were rendered.
(e) If a carrier retroactively denies reimbursement for services as a result of
coordination of benefits under provisions of subsection (b)(1)(i) of this section, the
health-care provider shall have 6 months from the date of denial, unless a carrier
permits a longer time period, to submit a claim for reimbursement for the service to
the carrier, Maryland Medical Assistance Program, or Medicare Program responsible
for payment.
Article - Health - General
19-706.
(o) The provisions of [§ 15-1008] §8 15-1008 AND 15-1009 of the Insurance
Article [shall] apply to health maintenance organizations.
Article - Insurance
15-1009.
(A) IN THIS SECTION, "CARRIER" MEANS:
(1) AN INSURER;
(2) A NONPROFIT HEALTH SERVICE PLAN;
(3) A HEALTH MAINTENANCE ORGANIZATION;
(4) A DENTAL PLAN ORGANIZATION; OR
(5) ANY OTHER PERSON THAT PROVIDES HEALTH BENEFIT PLANS
SUBJECT TO REGULATION BY THE STATE.
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- 2041 -
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