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Martin O'Malley, Governor Ch. 169
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(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:
(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; OR 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.
(2) A NONPARTICIPATING PROVIDER SHALL NOTIFY AN
ENROLLEE:
(I) THAT THE PROVIDER DOES NOT PARTICIPATE ON THE
PROVIDER PANEL OF THE ENROLLEE'S CARRIER: AND
(II) OF THE ANTICIPATED TOTAL CHARGES FOR THE
HEALTH CARE SERVICES.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2007.
Approved by the Governor, April 24, 2007.
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CHAPTER 170
(Senate Bill 635)
AN ACT concerning
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- 1337 -
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