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PARRIS N. GLENDENING, Governor
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Ch. 410
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(I) STANDARDS FOR ATTACHMENTS REQUIRED BY THE FEDERAL
HEALTH CARE FINANCING ADMINISTRATION FOR THE MEDICARE PROGRAM;
(II) STANDARDS USED BY INSURANCE CARRIERS, NONPROFIT
HEALTH SERVICE PLANS, AND HEALTH MAINTENANCE ORGANIZATIONS IN THE
STATE; AND
(III) FEDERAL REGULATIONS ADOPTED UNDER THE HEALTH
INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.
15-1004.
(A) IN THIS SECTION, "CLEAN CLAIM" MEANS A CLAIM FOR REIMBURSEMENT
AS DEFINED IN REGULATIONS ADOPTED BY THE COMMISSIONER UNDER
SUBSECTION (D) OF THIS SECTION.
[(a)](B) For services rendered by a person entitled to reimbursement under §
15-701(a) of this title or by a hospital, as defined in § 19-301 of the Health — General
Article, an insurer, [or] nonprofit health service plan, OR HEALTH MAINTENANCE
ORGANIZATION:
(1) [except as provided in subsection (c) of this section,] shall accept the
uniform claims form AND ANY ATTACHMENTS APPROVED OR adopted by the
Commissioner under § 15-1003 of this subtitle:
(i) as a properly filed claim with all necessary documentation; and
(ii) as the sole instrument for reimbursement; and
(2) may not impose as a condition of reimbursement a requirement to:
(i) modify the uniform claims form or its content; or
(ii) submit additional claims forms.
[(b)](C) (1) A uniform claims form submitted under this section shall be
completed properly IN ACCORDANCE WITH SUBSECTION (D) OF THIS SECTION and
may be submitted by electronic transfer.
(2) If the health care practitioner rendering the service is a certified
registered nurse anesthetist or certified nurse midwife, the uniform claims form shall
include identification modifiers for the certified registered nurse anesthetist or
certified nurse midwife that indicate whether the service is provided with or without
medical direction by a physician.
[(c) If IN ACCORDANCE WITH §§ 15-1003(D)(1)(II) AND 15-1005(C) OF THIS
SUBTITLE, IF the legitimacy or appropriateness of a health care service is disputed, an
insurer or, nonprofit health service plan, OR HEALTH MAINTENANCE ORGANIZATION
may request additional medical information that describes and summarizes the
diagnosis, treatment, and services rendered to the insured.]
(D) (1) THE COMMISSIONER SHALL ADOPT REGULATIONS DEFINING A
CLEAN CLAIM FOR PURPOSES OF THIS SECTION.
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- 2245 -
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