§ 9420. Conversion of nonprofit hospitals
§ 9420. Conversion of nonprofit hospitals (a) Policy and purpose. The State has a responsibility to assure that the assets of nonprofit entities, which are impressed with a charitable trust, are managed prudently and are preserved for their proper charitable purposes. (b) Definitions. As used in this section: (1) “Charitable assets” means the fair market […]
§ 9421. Pharmacy benefit management; registration; insurer audit of pharmacy benefit manager activities
§ 9421. Pharmacy benefit management; registration; insurer audit of pharmacy benefit manager activities (a) A pharmacy benefit manager shall not do business in this State without first registering with the Commissioner on a form and in a manner prescribed by the Commissioner. (b) In accordance with rules adopted by the Commissioner, pharmacy benefit managers operating […]
§ 9422. Credit card payments optional for providers
§ 9422. Credit card payments optional for providers (a) As used in this section: (1) “Credit card payment” means a type of electronic funds transfer in which a health insurer or its contracted vendor issues a single-use series of numbers associated with payment for health care services delivered by a health care provider and chargeable […]
§ 9418d. Contract amendments
§ 9418d. Contract amendments (a) A health care contract may be amended by mutual agreement of the parties. (b) Absent mutual agreement of the parties, a health care contract may be amended only as follows: (1) The contracting entity shall provide to the participating provider notice of the amendment and the amendment in writing not […]
§ 9418e. Most favored nation clauses prohibited
§ 9418e. Most favored nation clauses prohibited No later than 180 days after the effective date of this section, no contracting entity shall do any of the following: (1) offer to a provider, hospital, pharmacist, or pharmacy a health care contract that includes a most favored nation clause; (2) enter into a health care contract […]
§ 9418f. Rental network contracts
§ 9418f. Rental network contracts (a) Definitions. As used in this section: (1) “Health care services” means services for the diagnosis, prevention, treatment, or cure of a health condition, illness, injury, or disease. (2)(A) “Provider” means a physician, a physician organization, or a physician hospital organization that is acting exclusively as an administrator on behalf […]
§ 9418g. Enforcement
§ 9418g. Enforcement In addition to any other remedy provided by law, the Commissioner may, in his or her sole discretion, enforce the provisions of this subchapter as specified in this section. In determining whether to undertake an enforcement action, the Commissioner may consider the relative resources of the complaining party and the alleged noncompliant […]
§ 9419. Charges for access to medical records
§ 9419. Charges for access to medical records (a) A custodian may impose a charge that is no more than a flat $5.00 fee or no more than $0.50 per page, whichever is greater, for providing copies of an individual’s health care record. A custodian shall provide an individual or the authorized recipient with an […]
§ 9418. Payment for health care services
§ 9418. Payment for health care services (a) Except as otherwise specified, as used in this subchapter: (1) “Claim” means any claim, bill, or request for payment for all or any portion of provided health care services that is submitted by: (A) a health care provider or a health care facility pursuant to a contract […]
§ 9418a. Processing claims, downcoding, and adherence to coding rules
§ 9418a. Processing claims, downcoding, and adherence to coding rules (a) Health plans, contracting entities, covered entities, and payers shall accept and initiate the processing of all health care claims submitted by a health care provider pursuant to and consistent with the current version of the American Medical Association’s Current Procedural Terminology (CPT) codes, reporting […]