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<section article="gin" article_name="Insurance" number="15-112.1" future_version_removed="true" title_number="15" title_name="Health Insurance" subtitle_number="1" 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>“Carrier” means:</text>
        <level label="1">
          <text>an insurer;</text>
        </level>
        <level label="2">
          <text>a nonprofit health service plan;</text>
        </level>
        <level label="3">
          <text>a health maintenance organization;</text>
        </level>
        <level label="4">
          <text>a dental plan organization;</text>
        </level>
        <level label="5">
          <text>a managed care organization; or</text>
        </level>
        <level label="6">
          <text>any other person that provides health benefit plans subject to regulation by the State.</text>
        </level>
      </level>
      <level label="ii">
        <text>“Carrier” includes an entity that arranges a provider panel for a carrier.</text>
      </level>
    </level>
    <level label="3">
      <text>“Credentialing intermediary” means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.</text>
    </level>
    <level label="4">
      <text>“Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.</text>
    </level>
    <level label="5">
      <text>“Provider panel” means the providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.</text>
    </level>
    <level label="6">
      <text>“Uniform credentialing form” means the form designated by the Commissioner for use by a carrier or its credentialing intermediary for credentialing and recredentialing a health care provider for participation on a provider panel.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>Except as provided in subsection (c) of this section, a carrier or its credentialing intermediary shall accept the uniform credentialing form as the sole application for a health care provider to become credentialed or recredentialed for a provider panel of the carrier.</text>
    </level>
    <level label="2">
      <text>A carrier or its credentialing intermediary shall make the uniform credentialing form available to any health care provider that is to be credentialed or recredentialed by that carrier or credentialing intermediary.</text>
    </level>
  </level>
  <level label="c">
    <text>The requirements of subsection (b) of this section do not apply to a hospital or academic medical center that:</text>
    <level label="1">
      <text>is a participating provider on the carrier’s provider panel; and</text>
    </level>
    <level label="2">
      <text>acts as a credentialing intermediary for that carrier for health care practitioners that:</text>
      <level label="i">
        <text>participate on the carrier’s provider panel; and</text>
      </level>
      <level label="ii">
        <text>have privileges at the hospital or academic medical center.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <text>The Commissioner may impose a penalty not to exceed $500 against any carrier for each violation of this section by the carrier or its credentialing intermediary.</text>
  </level>
  <level label="e">
    <level label="1">
      <text>The Commissioner may adopt regulations to implement the provisions of this section.</text>
    </level>
    <level label="2">
      <text>The Commissioner may designate a provider credentialing application developed by a nonprofit alliance of health plans and trade associations for an online credentialing system offered to carriers and providers as the uniform credentialing form if:</text>
      <level label="i">
        <text>the provider credentialing application is available to providers at no charge; and</text>
      </level>
      <level label="ii">
        <text>use of the provider credentialing application is not conditioned on submitting the provider credentialing application to a carrier through the online credentialing system.</text>
      </level>
    </level>
  </level>
</section>
