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2007 Laws of Maryland
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Ch. 168
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5. any other person that provides health benefit plans
subject to regulation by the State.
(ii) "Carrier" includes an entity that arranges a provider panel
for a carrier.
(4) "Enrollee" means a person entitled to health care benefits from a
carrier.
(6) "Provider" means a health care practitioner or group of health care
practitioners licensed, certified, or otherwise authorized by law to provide health care
services.
(O) A CARRIER MAY NOT REQUIRE A PROVIDER THAT DELIVERS
HEALTH CARE SERVICES THROUGH A GROUP PRACTICE OR OTHER HEALTH
CARE ENTITY TO ACCEPT THE REIMBURSEMENT FEE SCHEDULE APPLICABLE
UNDER THE CONTRACT BETWEEN THE GROUP PRACTICE OR OTHER HEALTH
CARE ENTITY AND THE CARRIER FOR HEALTH CARE SERVICES THE PROVIDER
DELIVERS.
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(1) TO ENROLLEES OF THE CARRIER THROUGH A SEPARATE
INDIVIDUAL, GROUP, OR OTHER HEALTH CARE PRACTICE ARRANGEMENT; AND
(2) USING A DIFFERENT FEDERAL TAX IDENTIFICATION NUMBER
THAN THAT USED BY THE GROUP PRACTICE OR OTHER HEALTH-CARE ENTITY.
(O) (1) A CARRIER MAY NOT REQUIRE A PROVIDER THAT PROVIDES
HEALTH CARE SERVICES THROUGH A GROUP PRACTICE OR HEALTH CARE
FACILITY THAT PARTICIPATES ON THE CARRIER'S PROVIDER PANEL UNDER A
CONTRACT WITH THE CARRIER TO BE CONSIDERED A PARTICIPATING PROVIDER
OR ACCEPT THE REIMBURSEMENT FEE SCHEDULE APPLICABLE UNDER THE
CONTRACT WHEN:
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(I) PROVIDING HEALTH CARE SERVICES TO ENROLLEES OF
THE CARRIER THROUGH AN INDIVIDUAL OR GROUP PRACTICE OR HEALTH CARE
FACILITY THAT DOES NOT HAVE A CONTRACT WITH THE CARRIER; AND
(II) BILLING FOR HEALTH CARE SERVICES PROVIDED TO
ENROLLEES OF THE CARRIER USING A DIFFERENT FEDERAL TAX
IDENTIFICATION NUMBER THAN THAT USED BY THE GROUP PRACTICE OR
HEALTH CARE FACILITY UNDER A CONTRACT WITH THE CARRIER.
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- 1334 -
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