Section 15-1701 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Carrier” has the meaning stated in § 15–1301 of this title. (c) “Enrollee” means an individual entitled to health care benefits from a carrier. (d) “Physician rating system” means any program that: (1) measures, rates, or tiers the performance of physicians under contract with the carrier; and (2) discloses […]
Section 15-1702 – General Consideration
(a) A carrier may not use a physician rating system unless the physician rating system is approved by a ratings examiner. (b) A carrier shall contract with and pay for a ratings examiner to review any physician rating system of the carrier. (c) A physician rating system of a carrier is deemed to meet the requirements of this […]
Section 15-1703 – Appeals Process
(a) A carrier that uses a physician rating system shall: (1) establish an appeals process for physicians to use to contest their rating; and (2) at least 45 days before making available to enrollees any new or revised quality of performance or cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide […]
Section 15-1704 – Notification of Results of Review; Finding of Noncompliance; Reports
(a) A carrier shall notify the Commissioner of the results of any final review conducted by a ratings examiner of a physician rating system of the carrier within 45 calendar days after receipt of the results by the carrier. (b) If the review conducted by a ratings examiner of a physician rating system of a carrier indicates […]