|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PARRIS N. GLENDENING, Governor
|
|
|
|
|
|
S.B. 800
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(I) THE ESSENTIAL DATA ELEMENTS THAT MUST BE COMPLETED
ON THE UNIFORM CLAIMS FORM FOR THE CLAIM TO BE CONSIDERED A CLEAN
CLAIM;
(II) WHEN A CLAIM IS CONSIDERED RECEIVED BY THE INSURER,
NONPROFIT HEALTH SERVICE PLAN, OR HEALTH MAINTENANCE ORGANIZATION;
(III) THAT, EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS
SUBSECTION, REQUESTS FOR ATTACHMENTS SHALL COMPLY WITH THE STANDARDS
FOR ATTACHMENTS REQUIRED BY THE FEDERAL HEALTH CARE FINANCING
ADMINISTRATION FOR THE MEDICARE PROGRAM;
(IV) THAT INSURERS, NONPROFIT HEALTH SERVICE PLANS, AND
HEALTH MAINTENANCE ORGANIZATIONS SHALL PROVIDE AND UPDATE, AS
APPROPRIATE, ALL AFFECTED PROVIDERS CONTRACTING PROVIDERS AND ANY
OTHER PROVIDER ON REQUEST, WITH A MANUAL OR OTHER DOCUMENT THAT SETS
FORTH THE CLAIMS FILING PROCEDURES, INCLUDING:
1. (I) THE ADDRESS WHERE THE CLAIMS SHOULD BE
SENT FOR PROCESSING;
2. (II) THE TELEPHONE NUMBER AT WHICH PROVIDERS'
QUESTIONS AND CONCERNS REGARDING CLAIMS MAY BE ADDRESSED;
3. (III) THE NAME, ADDRESS, AND TELEPHONE NUMBER OF
ANY ENTITY TO WHICH THE INSURER, NONPROFIT HEALTH SERVICE PLAN, OR
HEALTH MAINTENANCE ORGANIZATION HAS DELEGATED THE CLAIMS PAYMENT
FUNCTION, IF APPLICABLE; AND
4. (IV) THE ADDRESS AND TELEPHONE NUMBER OF ANY
SEPARATE CLAIMS PROCESSING CENTER FOR SPECIFIC TYPES OF APPLICABLE
SERVICES, IF APPLICABLE; AND.
(V) (2) THAT IF AN INSURER, NONPROFIT HEALTH SERVICE
PLAN, OR HEALTH MAINTENANCE ORGANIZATION HAS DELEGATED ITS CLAIMS
PROCESSING FUNCTION TO A THIRD PARTY, THE DELEGATION AGREEMENT:
1. (I) SHALL REQUIRE THE CLAIMS PROCESSING ENTITY
TO COMPLY WITH THE REQUIREMENTS OF THIS SUBTITLE; AND
2. (II) MAY NOT BE CONSTRUED TO LIMIT THE
RESPONSIBILITY OF THE INSURER, NONPROFIT HEALTH SERVICE PLAN, OR HEALTH
MAINTENANCE ORGANIZATION TO COMPLY WITH THE REQUIREMENTS OF THIS
SUBTITLE.
(3) ADDITIONAL DATA ELEMENTS OR ATTACHMENTS MAY NOT BE
REQUIRED UNLESS;
(I) APPROVED BY THE COMMISSIONER;
(II) MADE APPLICABLE TO ALL INSURERS, NONPROFIT HEALTH
SERVICE PLANS, AND HEALTH MAINTENANCE ORGANIZATIONS; AND
|
|
|
|
|
|
|
|
|
|
- 4163 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
 |
