Md. Code Regs. 31.10.41.03

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

Section 31.10.41.03 - 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 only the monies for the items identified in Insurance Article, § 14-205.2(b)(3), Annotated Code of Maryland;

(3) Submit to the carrier the uniform claims form required by COMAR 31.10.11.03B and indicate acceptance of the assignment of benefits in box 27 of the uniform claims form to satisfy the notice requirements under Insurance Article, § 14-205.2(a)(3), Annotated Code of Maryland; and

(4) Designate CPT code 99026, or its successor, on the uniform claims form.

C. A carrier shall reimburse a nonpreferred provider who is an on-call physician and who has provided the information specified in §B(3) and (4) of this regulation in accordance with the provisions of Insurance Article, § 14-205.2(c), Annotated Code of Maryland.

Md. Code Regs. 31.10.41.03