<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 31.10.11.07" title_num="31" subtitle_num="10" chapter_num="11" heading="General Provisions.">
  <paragraph num="A.">
    <text>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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A third-party payor is subject to the provisions of Insurance Article, §15-1005, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
  <paragraph num="D.">
    <text>A third-party payor shall accept current coding changes by the effective date of the changes set forth by the developers of the codes.</text>
  </paragraph>
  <paragraph num="E.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Date of birth;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Subscriber's plan identification number; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Other personally identifying information.</text>
    </paragraph>
  </paragraph>
</regulation>