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Session Laws, 2004
Volume 801, Page 654   View pdf image
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Ch. 155                                    2004 LAWS OF MARYLAND

(2) send a notice of receipt and status of the claim that states:

(i) that the insurer, nonprofit health service plan, or health
maintenance organization refuses to reimburse all or part of the claim and the reason
for the refusal;

(ii) that, in accordance with § 15-1003(d)(1)(ii) of this subtitle, the
legitimacy of the claim or the appropriate amount of reimbursement is in dispute and
additional information is necessary to determine if all or part of the claim will be
reimbursed and what specific additional information is necessary; or

(iii) that the claim is not clean and the specific additional
information necessary for the claim to be considered a clean claim.

(d)     (1) An insurer, nonprofit health service plan, or health maintenance
organization shall permit a provider a minimum of 180 days from the date a covered
service is rendered to submit a claim for reimbursement for the service.

(2) If an insurer, nonprofit health service plan, or health maintenance
organization wholly or partially denies a claim for reimbursement, the insurer,
nonprofit health service plan, or health maintenance organization shall permit a
provider a minimum of 90 working days after the date of denial of the claim to appeal
the denial.

(e)     (1) If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(i) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall [pay] MAIL
OR OTHERWISE TRANSMIT PAYMENT FOR any undisputed portion of the claim within
30 days of receipt of the claim, in accordance with this section.

(2)     If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(ii) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall:

(i) [pay] MAIL OR OTHERWISE TRANSMIT PAYMENT FOR any
undisputed portion of the claim in accordance with this section; and

(ii) comply with subsection (c)(1) or (2)(i) of this section within 30
days after receipt of the requested additional information.

(3)     If an insurer, nonprofit health service plan, or health maintenance
organization provides notice under subsection (c)(2)(iii) of this section, the insurer,
nonprofit health service plan, or health maintenance organization shall comply with
subsection (c)(1) or (2)(i) of this section within 30 days after receipt of the requested
additional information.

(f)      (1) If an insurer, nonprofit health service plan, or health maintenance
organization fails to comply with subsection (c) of this section, the insurer, nonprofit
health service plan, or health maintenance organization shall pay interest on the
amount of the claim that remains unpaid 30 days after the claim is received at the
monthly rate of:

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Session Laws, 2004
Volume 801, Page 654   View pdf image
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