Md. Code Regs. 31.10.26.02

Current through Register Vol. 51, No. 18, September 6, 2024

Section 31.10.26.02 - 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; or

(v) Any other person that provides health benefit plans subject to regulation by the State.

(b) "Carrier" includes an entity that arranges a provider panel for a carrier.

(2) "Credentialing intermediary" means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.

(3) "Health benefit plan" means:

(a) A hospital or medical policy, contract, or certificate, including those issued under multiple employer trusts or associations;

(b) A hospital or medical policy, contract, or certificate issued by a nonprofit health service plan;

(c) A health maintenance organization contract; or

(d) A dental plan organization contract.

(4) "Health care provider" means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article, Annotated Code of Maryland, to provide health care services.

(5) "Provider panel" means the health care providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.

(6) "Uniform credentialing form" means the form designated by the Insurance Commissioner for use by a carrier or its credentialing intermediary for credentialing and recredentialing a health care provider for participation on a provider panel.

Md. Code Regs. 31.10.26.02