Regulation .07 General Provisions.
Regulation .07 General Provisions.LinkCopy Citation
A.
A third-party payor shall accept a clean claim which is submitted in compliance with these regulations for the processing of the third-party payor's claims.
B.
A third-party payor is subject to the provisions of Insurance Article, §15-1005, Annotated Code of Maryland.
C.
If a third party payor delegates its claims processing to another entity, the third-party payor is responsible for a violation by the entity of any regulation under this chapter.
D.
A third-party payor shall accept current coding changes by the effective date of the changes set forth by the developers of the codes.
E.
If a referral is required under Regulation .10 of this chapter, a third party payor may not deny a claim on the basis that a referral was not received unless the third party payor could not identify the member using the member's name and the following information specified on the referral form:
(1)
Date of birth;
(2)
Subscriber's plan identification number; or
(3)
Other personally identifying information.