31.10.12.03

.03 Uniform Consultation Referral Form — Carrier Requirements.

A. If a carrier requires a covered person to have a written referral in order to receive services, the carrier shall use the uniform consultation referral form as defined in Regulation .02B(6) of this chapter.

B. The carrier may not impose as a condition of coverage a requirement to:

(1) Modify the uniform consultation referral form, except as provided in E of this regulation; or

(2) Submit additional consultation referral forms.

C. The carrier may provide a separate set of instructions for properly completing the Uniform Consultation Referral Form.

D. For the uniform consultation referral form, the carrier’s specific instructions:

(1) If applicable, may be preprinted on the back of the uniform consultation referral form, if the instructions do not result in any modifications in the format of, or information categories directed to be supplied on the front of, the uniform consultation referral form; and

(2) Shall be made available to primary or requesting providers on the carrier’s website.

E. Notwithstanding the provisions of §B of this regulation, the carrier may provide stamps or preprinted stickers to include additional information to the carrier information block on the uniform consultation referral form.

F. The carrier may preprint the designated carrier information in the carrier information field on the Maryland uniform consultation referral form.