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Ch. 646
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Martin O'Malley, Governor
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(3) A HEALTH MAINTENANCE ORGANIZATION;
(4) A DENTAL PLAN ORGANIZATION; AND
(5) ANY OTHER PERSON EXCLUDED AS A THIRD PARTY IN §
1902(A)(25)(A) OF THE SOCIAL SECURITY ACT, AS AMENDED BY THE FEDERAL
DEFICIT REDUCTION ACT OF 2005.
(B) (1) A CARRIER SHALL PROVIDE, AT THE REQUEST OF THE
DEPARTMENT, INFORMATION ABOUT INDIVIDUALS WHO ARE ELIGIBLE FOR
BENEFITS UNDER THE PROGRAM OR ARE PROGRAM RECIPIENTS SO THAT THE
DEPARTMENT MAY DETERMINE WHETHER AN INDIVIDUAL, THE SPOUSE OF AN
INDIVIDUAL, OR THE DEPENDENT OF AN INDIVIDUAL IS RECEIVING HEALTH
CARE COVERAGE FROM A CARRIER AND THE NATURE OF THAT COVERAGE.
(2) A CARRIER SHALL PROVIDE THE INFORMATION REQUIRED
UNDER THIS SUBSECTION IN A MANNER PRESCRIBED BY THE DEPARTMENT.
(C) A CARRIER SHALL ACCEPT THE PROGRAM'S RIGHT OF RECOVERY
AND THE ASSIGNMENT TO THE PROGRAM OF ANY RIGHT OF AN INDIVIDUAL OR
OTHER ENTITY TO PAYMENT FROM THE CARRIER FOR AN ITEM OR SERVICE FOR
WHICH PAYMENT HAS BEEN MADE UNDER THE PROGRAM IF THE CARRIER HAS A
LEGAL OBLIGATION TO MAKE PAYMENT FOR THE ITEM OR SERVICE.
(D) A CARRIER SHALL RESPOND TO ANY INQUIRY BY THE DEPARTMENT
REGARDING A CLAIM FOR PAYMENT FOR ANY HEALTH CARE ITEM OR SERVICE
THAT IS SUBMITTED NOT LATER THAN 3 YEARS AFTER THE DATE OF THE
PROVISION OF THE HEALTH-CARE ITEM OR SERVICE.
(E) A CARRIER MAY NOT DENY A CLAIM SUBMITTED BY THE PROGRAM
SOLELY ON THE BASIS OF THE DATE OF SUBMISSION OF THE CLAIM, THE TYPE
OR FORMAT OF THE CLAIM FORM, OR FAILURE OF THE PROGRAM TO PRESENT
PROPER DOCUMENTATION AT THE POINT OF SALE THAT IS THE BASIS OF THE
CLAIM, IF:
(1) THE CLAIM IS SUBMITTED BY THE PROGRAM WITHIN 3 YEARS
AFTER THE ITEM OR SERVICE WAS PROVIDED; AND
(2) THE PROGRAM COMMENCES AN ACTION TO ENFORCE ITS
RIGHTS WITH RESPECT TO THE CLAIM WITHIN 6 YEARS OF SUBMISSION OF THE
CLAIM BY THE PROGRAM.
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- 4057 -
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