§ 1-208. Uniform claims forms

   (a) Definitions. --

   (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 only applies 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 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) Use required. -- When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form.

(c) Completion; transfer. -- The uniform claims form submitted under this section:

   (1) Shall be properly completed; and

   (2) May be submitted by electronic transfer.

(d) Penalty. -- The Secretary may impose a penalty not to exceed $ 100 on any health care practitioner that violates the provisions of this section.

HISTORY: 1992, ch. 613; 1994, ch. 3, § 1; 1995, ch. 3, § 1; 1997, ch. 70, § 4.