Skip to Main Content
<< Back | Return to Main COMAR Search Page

11 records match your request.

FileAbstract
10.25.09.00.htm 10.25.09.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 25 MARYLAND HEALTH CARE COMMISSION Chapter 09 Requirements for Payers to Designate Electronic Health Networks Authority: Health-General Article, §4-302.1, 19-101, 19-103(c)9) and (10) 19-109(a)1) and 19-134(a) and (b) Annotated Code of Maryland
10.25.09.01.htm 10.25.09.01. 01 Scope.. A. This chapter applies to a third-party payer operating in the State of Maryland, as of July 1, 1997, whose premium volume exceeds $1,000,000 as reported in the most recent annual statement in the hands of the Maryland Insurance Administration as of December 1 of each calendar year.B. At the discretion of the Maryland Health Care Commission, this chapter may also apply to third party payers operating in the State of Maryland whose premium volume is $1,000,000 or less.
10.25.09.02.htm 10.25.09.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Adjudication" means paid, resolved, or settled.. 2) "Commission" or "MHCC" means the Maryland Health Care Commission.. 3) "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, P.L. No. 104―191, 42 U.S.C. Title XI, Part C.4) "Deputy Director" means the Deputy Director for Data Systems and Analysis at the Maryland Health Care Commission, or the D
10.25.09.03.htm 10.25.09.03. 03 EHN Designation.. A. Payers shall only contract with MHCC-certified EHNs for the exchange of electronic health care transactions that originate in Maryland.B. In the event that a designated EHN loses its MHCC-certified status, the Commission shall provide written notice to the payer of the event.C. Within 60 days from the date of the notice, the payer shall notify the Commission that it is no longer using that EHN for the exchange of electronic health care transactions.
10.25.09.04.htm 10.25.09.04. 04 Designation Requirements.. The payer and its designated EHNs shall enter into a written agreement that shall address at minimum each of the following:A. Transaction format specifications;. B. Transmission methods to be used;. C. Schedules of events, such as transmission cutoffs, acknowledgment requirements, reporting requirements, and scheduled outages, etc;D. Editing requirements and schedules for changes or enhancements;. E. Charges and terms of payment; and.
10.25.09.05.htm 10.25.09.05. 05 EDI Progress Report.. A. On or before June 30 of each year, each payer shall submit to the Commission an EDI Progress Report Form, describing certain electronic health care transaction activity for the payer's previous calendar year as described in this regulation.B. This report shall include:. 1) A certification of compliance with Health-General Article, §4-302.1, Annotated Code of Maryland;. 2) Health care transactions as defined by HIPAA Transaction and Code Set St
10.25.09.06.htm 10.25.09.06. 06 Waiver or Exception Request.. A. A payer may submit a written request for waiver or exception of the reporting requirements.. B. The payer shall:. 1) Submit a written request for a waiver or exception to the Deputy Director not later than 30 days before the due date of meeting the reporting/designation requirements; and2) Explain the reason for the waiver request.. C. The Deputy Director shall grant a reasonable request for good cause shown..
10.25.09.07.htm 10.25.09.07. 07 Extension of Time.. A. A payer may request an extension of time of up to 60 days for submission of the EDI information.. B. The payer shall:. 1) Submit the request in writing to the Deputy Director for Data Systems and Analysis not later than 30 days before the reporting deadline;2) Explain the reason for the extension request; and. 3) Propose a reasonable date for submission.. C. A payer may file a written petition for review of a denial of an extension of time..
10.25.09.08.htm 10.25.09.08. 08 Penalties for Failure to File a Report.. A. Unless the Deputy Director has granted an extension of time, a payer that does not timely file a report is liable for a monetary penalty of $1,000 per day for each day the filing of the report is delayed.B. A report that is substantially incomplete or inaccurate is not timely filed.. C. The filing of a written petition for review of a denial of an extension of time stays the accrual of the monetary penalty under §A of these regulations.
10.25.09.09.htm 10.25.09.09. 09 Penalties for Failure to Contract with a MHCC-Certified EHN.. A. Unless the Deputy Director has granted an extension of time, a payer that does not contract with an MHCC-Certified EHN within 60 days of notification by MHCC that the EHN is not certified, is liable for a monetary penalty of $1,000 per day.B. The filing of a written petition for an extension of time stays the accrual of the monetary penalty under §A of this regulation.C. If the Commission affi
10.25.09.9999.htm 10.25.09.9999. Administrative History Effective date: July 15, 1996 (23:14 Md. R. 1009). Regulation .02 amended effective July 23, 2001 (28:14 Md. R. 1322). Regulation .03 amended as an emergency provision effective May 1, 1997 (24:11 Md. R. 792) emergency status expired October 1, 1997; amended permanently effective October 20, 1997 (24:21 Md. R. 1450)Regulation .03 amended effective July 23, 2001 (28:14 Md. R. 1322). Regulation .05A amended effective July 23, 2001 (28:14 Md. R. 1322) ―.
<< Back | Return to Main COMAR Search Page