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31.10.41.00.htm 31.10.41.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 41 Assignment of Benefits to Nonpreferred Providers Authority: Insurance Article, §2-109(a)1) 14-205.2, and 14-205.3, Annotated Code of Maryland
31.10.41.01.htm 31.10.41.01. 01 Applicability.. This chapter applies to preferred provider insurance policies that are issued, renewed, or delivered by a carrier in the State on or after July 1, 2011.
31.10.41.02.htm 31.10.41.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Allowed amount” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.2) “Assignment of benefits” has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.3) “Carrier” means an insurer or nonprofit health service plan.. 4) "Covered service" has the meaning stated in Insurance Article, §14-201, Annotated Code of Maryland.
31.10.41.03.htm 31.10.41.03. 03 Assignment of Benefits ― On-Call Physicians.. A. A nonpreferred provider who is an on-call physician may accept an assignment of benefits under a preferred provider insurance policy.B. A nonpreferred provider who is an on-call physician and accepts an assignment of benefits under a preferred provider insurance policy shall:1) Accept the carrier’s allowed amount as payment in full for the covered services provided;. 2) Collect or attempt to collect from the insured
31.10.41.04.htm 31.10.41.04. 04 Assignment of Benefits ― Hospital-Based Physicians.. A. A nonpreferred provider who is a hospital-based physician may accept an assignment of benefits under a preferred provider insurance policy.B. A nonpreferred provider who is a hospital-based physician and accepts an assignment of benefits under a preferred provider insurance policy shall:1) Accept the carrier’s allowed amount as payment in full for the covered services provided;. 2) Collect or attempt to
31.10.41.05.htm 31.10.41.05. 05 Assignment of Benefits ― Nonpreferred Providers.. A. This regulation applies to carriers who receive claims for services provided by physicians who are nonpreferred providers but are not on-call physicians or hospital-based physicians.B. A carrier shall permit a nonpreferred provider described in §A of this regulation to accept an assignment of benefits under a preferred provider insurance policy offered by the carrier.C. Except as provided in Insurance Article, §14-20
31.10.41.06.htm 31.10.41.06. 06 Required Disclosure for Nonpreferred Providers Seeking Assignment of Benefits.. A. Except for a nonpreferred provider who is an on-call physician or a hospital-based physician, a nonpreferred provider who is a physician shall provide a copy of the disclosure set forth in §B of this regulation to each insured before performing a health care service for the insured in order to qualify for an assignment of benefits under a preferred provider insurance poB. The disclosure text re
31.10.41.07.htm 31.10.41.07. 07 Notice to Insureds by Carriers.. A. A carrier shall provide the information listed in §B of this regulation with the payment to the insured for health care services if:1) The carrier receives a claim for health care services provided by a physician who is a nonpreferred provider and who is not an on-call physician or a hospital-based physician; and2) The insured did not provide an assignment of benefits to the physician who provided the health care services.
31.10.41.9999.htm 31.10.41.9999. Administrative History Effective date: September 19, 2011 (38:19 Md. R. 1148).
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