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31.10.16.00.htm 31.10.16.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE โ€• GENERAL Chapter 16 Carrier Provider Panels โ€• Application Process Authority: Insurance Article, ยง2-109 and 15-112, Annotated Code of Maryland
31.10.16.01.htm 31.10.16.01. 01 Applicability.. This chapter applies to all insurers, nonprofit health service plans, health maintenance organizations, dental plans, and to any other person or organization which utilizes a provider panel and which provides health benefit plans subject to regulation in this State.
31.10.16.02.htm 31.10.16.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) Carrier.. a) "Carrier" means:. i) An insurer;. ii) A nonprofit health service plan;. iii) A health maintenance organization;. iv) A dental plan organization; and. v) Any other person or organization that provides health benefit plans subject to State regulation.. b) "Carrier" includes an entity that arranges a provider panel for a carrier.. 2) "Provider" means a hea
31.10.16.03.htm 31.10.16.03. 03 Requirements for Application Process.. A. A carrier that utilizes a provider panel shall establish written procedures for reviewing applications for participation in the provider panel.B. A carrier that utilizes a provider panel shall, upon request, make its applications publicly available.C. The form of application:. 1) Shall include instructions for completion of the application;. 2) Shall provide a specifically designated space for dating the receipt of
31.10.16.04.htm 31.10.16.04. 04 Application Fees.. A. A carrier may charge a reasonable fee for any application that a provider submits to the carrier.. B. The fee shall be nonrefundable and uniform for all applicants within a practice specialty.. C. The fee may not exceed $75 for each provider application.. D. A carrier may not charge additional fees for processing an application which was returned because of insufficient information.
31.10.16.05.htm 31.10.16.05. 05 Document Retention.. A. A carrier shall maintain its provider application log for a minimum of 3 years or until its next market conduct examination, whichever occurs last.B. A carrier shall:. 1) Date stamp each application received from a provider upon initial receipt; and. 2) Maintain a legible copy of each application, and any correspondence regarding that application, for a minimum of 3 years or until its next market conduct examination, whichever occurs last.
31.10.16.9999.htm 31.10.16.9999. Administrative History Effective date: June 17, 1996 (23:12 Md. R. 870) โ€•. Chapter recodified from COMAR 09.31.13 to COMAR 31.10.16, July 1998. Regulation .03C amended effective April 21, 2008 (35:8 Md. R. 812). Regulation .03D amended effective May 9, 2016 (43:9 Md. R. 532). Regulation .03F amended effective December 23, 2002 (29:25 Md. R. 1984). Regulation .05B amended effective December 6, 2018 (45:24 Md. R. 1164).
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