Section 1-208 - Uniform Claims Forms

(a) (1) In this section the following words have the meanings indicated. (2) (i) Except as otherwise provided in this paragraph, 'health care practitioner' means a physician or any other person licensed or certified under this article and reimbursed by a third party payor. (ii) Subject to the provisions of subparagraph (iii) of this paragraph, 'health care practitioner' does not include a physician or other person licensed or certified under this article who is compensated by a health maintenance organization on a salaried or capitated basis. (iii) The exclusion provided under subparagraph (ii) of this paragraph applies only when the physician or other licensed or certified person is rendering care to a member or subscriber of the health maintenance organization on a salaried or capitated system basis. (3) 'Third party payor' means any person that administers or provides reimbursement for health care benefits on an expense incurred basis including: (i) A health maintenance organization issued a certificate of authority in accordance with Title 19, Subtitle 7 of the Health – General Article; (ii) A health insurer or nonprofit health service plan authorized to offer health insurance

issued a certificate of authority in accordance with Title 19, Subtitle 7 of the Health – General Article; (ii) A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or (iii) A third party administrator registered under the Insurance Article. (4) 'Uniform claims form' means the claim or billing form for reimbursement of services rendered by a health care practitioner adopted by the Insurance Commissioner under § 15–1003 of the Insurance Article. (b) When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form. (c) The uniform claims form submitted under this section: (1) Shall be properly completed; and (2) May be submitted by electronic transfer. (d) The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section.