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<section article="gho" article_name="Health Occupations" number="1-208" title_number="1" title_name="Definitions; General Provisions" subtitle_number="2" subtitle_name="General Provisions">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <level label="i">
        <text>Except as otherwise provided in this paragraph, “health care practitioner” means a physician or any other person licensed or certified under this article and reimbursed by a third party payor.</text>
      </level>
      <level label="ii">
        <text>Subject to the provisions of subparagraph (iii) of this paragraph, “health care practitioner” does not include a physician or other person licensed or certified under this article who is compensated by a health maintenance organization on a salaried or capitated basis.</text>
      </level>
      <level label="iii">
        <text>The exclusion provided under subparagraph (ii) of this paragraph applies only when the physician or other licensed or certified person is rendering care to a member or subscriber of the health maintenance organization on a salaried or capitated system basis.</text>
      </level>
    </level>
    <level label="3">
      <text>“Third party payor” means any person that administers or provides reimbursement for health care benefits on an expense incurred basis including:</text>
      <level label="i">
        <text>A health maintenance organization issued a certificate of authority in accordance with Title 19, Subtitle 7 of the Health – General Article;</text>
      </level>
      <level label="ii">
        <text>A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or</text>
      </level>
      <level label="iii">
        <text>A third party administrator registered under the Insurance Article.</text>
      </level>
    </level>
    <level label="4">
      <text>“Uniform claims form” means the claim or billing form for reimbursement of services rendered by a health care practitioner adopted by the Insurance Commissioner under § 15–1003 of the Insurance Article.</text>
    </level>
  </level>
  <level label="b">
    <text>When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form.</text>
  </level>
  <level label="c">
    <text>The uniform claims form submitted under this section:</text>
    <level label="1">
      <text>Shall be properly completed; and</text>
    </level>
    <level label="2">
      <text>May be submitted by electronic transfer.</text>
    </level>
  </level>
  <level label="d">
    <text>The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section.</text>
  </level>
</section>
