Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.16 - Carrier Provider Panels - Application Process
Section 31.10.16.03 - Requirements for Application Process
Universal Citation: MD Code Reg 31.10.16.03
Current through Register Vol. 51, No. 19, September 20, 2024
A. A carrier that utilizes a provider panel shall establish written procedures for reviewing applications for participation in the provider panel.
B. A carrier that utilizes a provider panel shall, upon request, make its applications publicly available.
C. The form of application:
(1) Shall include instructions for completion of the application;
(2) Shall provide a specifically designated space for dating the receipt of the application by the carrier; and
(3) Shall comply with federal and State laws concerning the Americans with Disability Act.
D. A carrier shall maintain an application log which, at a minimum, provides the following information:
(1) Name of the provider requesting or submitting the application;
(2) Date the provider requested an application, if applicable;
(3) Date the application is sent or delivered to the provider, if applicable;
(4) Date the application is received from the provider;
(5) Date the application is returned to the provider with a request for additional information to complete the application, if applicable;
(6) Date of receipt by the carrier of an application previously returned for additional information, if applicable;
(7) Date that the provider is notified of:
(a) Rejection, or
(b) Carrier's intent to continue the credentialing process; and
(8) Date after completion of credentialing that the provider is notified of acceptance or rejection in the provider panel.
E. The log shall be available for inspection by the Commissioner.
F. Notice.
(1) A carrier shall:
(a) If the carrier maintains a web site:
(i) Post on the web site a notice of how to apply to the carrier's provider panel; and
(ii) Provide, on request, a paper copy of the notice of how to apply to the carrier's provider panel; or
(b) If the carrier does not maintain a web site, provide on request a paper copy of the notice of how to apply to the carrier's provider panel.
(2) The notice required pursuant to §F(1) of this regulation shall include relevant addresses and telephone numbers for contact purposes.
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