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S.B. 800
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VETOES
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Annotated Code of Maryland
(1996 Replacement Volume and 1999 Supplement)
BY repealing and reenacting, with amendments,
Article - Insurance
Section 15-1003, 15-1004i and 15-1005
Annotated Code of Maryland
(1997 Volume and 1999 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND, That the Laws of Maryland read as follows:
Article - Health - General
19-706.
(kk) The provisions of [§ 15-1005] §§ 15-1003. 15-1004, AND 15-1005 of the
Insurance Article apply to health maintenance organizations.
[19-712.3.
(a) Except as provided in subsection (d) of this section, for services rendered to
its members or subscribers, a health maintenance organization shall accept as a
properly filed claim and the sole instrument for reimbursement the uniform claims
form submitted by a hospital or health care practitioner in accordance with § 15-1003
of the Insurance Article.
(b) The uniform claims form submitted under this section:
(1) Shall be properly completed; and
(2) May be submitted by electronic transfer.
(c) A health maintenance organization may not impose as a condition of
payment any requirements on a hospital or health care practitioner to:
(1) Modify the uniform claims form or its content; or
(2) Submit additional claims forms.
(d) When the legitimacy or appropriateness of the health care service is
disputed, a health maintenance organization may request additional medical
information that describes and summarizes the diagnosis, treatment, and services
rendered to the member or subscriber.
(e) When necessary to determine eligibility for benefits or for determination of
coverage, a health maintenance organization may obtain additional information from
its subscriber or member, the employer of trie subscriber or member, or any other
non-provider third party, provided that any delays in paying a uniform claim
resulting from obtaining this information are subject to the provisions of §
19-712.1(b) of this subtitle.
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