(a) (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) When submitting a claim or bill for reimbursement to a third party
payor, a health care practitioner shall use the uniform claims form.
(c) The uniform claims form submitted under this section:
(1) Shall be properly completed; and
(2) May be submitted by electronic transfer.
(d) The Secretary may impose a penalty not to exceed $100 on any health
care practitioner that violates the provisions of this
section.
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