Md. Code Regs. 31.10.41.05

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.41.05 - 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, § 14-205.3(g), Annotated Code of Maryland, a carrier that receives a claim for services provided by a nonpreferred provider described in §A of this regulation who accepts an assignment of benefits under a preferred provider insurance policy shall pay the nonpreferred provider directly if the nonpreferred provider:

(1) Provides a copy of the disclosure set forth in Regulation .06 of this chapter to an insured before performing a health care service for the insured; and

(2) Submits a copy of the signed disclosure set forth in Regulation .06 of this chapter to the carrier.

Md. Code Regs. 31.10.41.05