Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.41 - Assignment of Benefits to Nonpreferred Providers
Section 31.10.41.05 - Assignment of Benefits - Nonpreferred Providers

Universal Citation: MD Code Reg 31.10.41.05

Current through Register Vol. 51, No. 19, September 20, 2024

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.

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