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S.B. 557
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Martin O'Malley, Governor
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(4) "CREDENTIALING INTERMEDIARY" MEANS A PERSON TO
WHOM A CARRIER HAS DELEGATED CREDENTIALING OR RECREDENTIALING
AUTHORITY AND RESPONSIBILITY.
(5) "Enrollee" means a person entitled to health care benefits from a
carrier.
[(5)] (6) "Hospital" has the meaning stated in § 19-301 of the Health
- General Article.
[(6)] (7) "Provider" means a health care practitioner or group of
health care practitioners licensed, certified, or otherwise authorized by law to provide
health care services.
[(7)] (8) (i) "Provider panel" means the providers that contract
either directly or through a subcontracting entity with a carrier to provide health care
services to the carrier's enrollees under the carrier's health benefit plan.
(ii) "Provider panel" does not include an arrangement in which
any provider may participate solely by contracting with the carrier to provide health
care services at a discounted fee-for-service rate.
(d) (1) A provider that seeks to participate on a provider panel of a carrier
shall submit an application to the carrier.
(2) (i) Subject to paragraph (3) of this subsection, the carrier, after
reviewing the application, shall accept or reject the provider for participation on the
carrier's provider panel.
(ii) If the carrier rejects the provider for participation on the
carrier's provider panel, the carrier shall send to the provider at the address listed in
the application written notice of the rejection.
(3) (i) Except as provided in paragraph (4) of this subsection,
within 30 days after the date a carrier receives a completed application, the carrier
shall send to the provider at the address listed in the application written notice of:
1. the carrier's intent to continue to process the
provider's application to obtain necessary credentialing information; or
2. the carrier's rejection of the provider for participation
on the carrier's provider panel.
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- 4301 -
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