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Chapter 12. Uniform Consultation Referral

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Regulation .01 Applicability and Scope.Copy Citation

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This chapter is applicable to all:
A.
Carriers as defined in Regulation .02B(1) of this chapter;
B.
Consultant/facility providers as defined in Regulation .02B(2) of this chapter; and
C.
Primary or requesting providers as defined in Regulation .02B(4) of this chapter.

Regulation .02 Definitions.Copy Citation

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A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Carrier” means:
(a)
An insurer;
(b)
A nonprofit health service plan;
(c)
A health maintenance organization; or
(d)
A dental plan organization.
(2)
“Consultant/facility provider” means:
(a)
A person licensed or certified under Health Occupations Article, Annotated Code of Maryland, who receives a referral from a primary or requesting provider; or
(b)
Hospitals and related institutions that receive a referral from a primary or requesting provider.
(3)
“Hospital” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland.
(4)
“Primary or requesting provider” means a person licensed or certified under the Health Occupations Article, Annotated Code of Maryland, who refers patients for consultation to a consultant/facility provider.
(5)
“Related institution” has the meaning stated in Health-General Article, §19-301, Annotated Code of Maryland.
(6)
“Uniform consultation referral form” means:
(a)
For dentists referring patients for dental care procedures or services, the Maryland Uniform Dental Consultation Referral Form or its electronic equivalent shown in Regulation .08 of this chapter; or
(b)
For all other health care professionals referring patients for health, medical, or dental care procedures or services, the Maryland Uniform Consultation Referral Form or its electronic equivalent shown in Regulation.06 of this chapter.

Regulation .03 Uniform Consultation Referral Form — Carrier Requirements.Copy Citation

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A.
If a carrier requires a covered person to have a written referral in order to receive services, the carrier shall use the uniform consultation referral form as defined in Regulation .02B(6) of this chapter.
B.
The carrier may not impose as a condition of coverage a requirement to:
(1)
Modify the uniform consultation referral form, except as provided in §E of this regulation; or
(2)
Submit additional consultation referral forms.
C.
The carrier may provide a separate set of instructions for properly completing the Uniform Consultation Referral Form.
D.
For the uniform consultation referral form, the carrier’s specific instructions:
(1)
If applicable, may be preprinted on the back of the uniform consultation referral form, if the instructions do not result in any modifications in the format of, or information categories directed to be supplied on the front of, the uniform consultation referral form; and
(2)
Shall be made available to primary or requesting providers on the carrier’s website.
E.
Notwithstanding the provisions of §B of this regulation, the carrier may provide stamps or preprinted stickers to include additional information to the carrier information block on the uniform consultation referral form.
F.
The carrier may preprint the designated carrier information in the carrier information field on the Maryland uniform consultation referral form.

Regulation .04 Uniform Consultation Referral Form — Primary or Requesting Provider.Copy Citation

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A.
The primary or requesting provider shall use the uniform consultation referral form as defined in Regulation .02B(6) of this chapter and instructions as provided in Regulation .03C of this chapter.
B.
The uniform consultation referral form shall be properly completed by the primary or requesting provider.

Regulation .05 Uniform Consultation Referral Form — Consultant/Facility Provider.Copy Citation

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The consultant/facility provider shall accept a properly completed uniform consultation referral form.

Regulation .06 General Provisions.Copy Citation

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A.
The requirements under these regulations do not apply to an entity that would be using a consultation form solely for internal purposes.
B.
The Maryland Uniform Consultation Referral Form shall read as follows:
C.
The electronic equivalent of the uniform consultation referral form is as follows:

Regulation .07 Electronic Transfer of the Uniform Consultation Referral Form.Copy Citation

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A.
A transmission by facsimile is not considered an electronic transfer for the purposes of this chapter.
B.
A carrier shall accept the electronic transfer of the uniform consultation referral form.

Regulation .08 Uniform Consultation Referral Form — Required Forms.Copy Citation

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A.
The Maryland Uniform Dental Consultation Referral Form shall read as follows:
B.
The electronic equivalent of the uniform consultation referral form is as follows:
Chapter annotations
Authority: Insurance Article, §§2-109 and 15-120, Annotated Code of Maryland
History: Effective date: October 21, 1996 (23:21 Md. R. 1467)
History: Regulation .03 amended as an emergency provision effective January 28, 1997 (24:4 Md. R. 289); adopted permanently effective May 19, 1997 (24:10 Md. R. 710)
History: Regulation .07 adopted as an emergency provision effective January 28, 1997 (24:4 Md. R. 289); adopted permanently effective May 19, 1997 (24:10 Md. R. 710)
History: Chapter recodified from COMAR 09.31.23 to COMAR 31.10.12 effective September 7, 1998 (25:18 Md. R. 1439)
History: Regulation .02B amended effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)
History: Regulation .03 amended effective January 13, 2011 (38:1 Md. R. 12)
History: Regulation .03A amended effective January 1, 2005 (31:23 Md. R. 1655)
History: Regulation .04A amended effective January 1, 2005 (31:23 Md. R. 1655)
History: Regulation .05 amended effective January 13, 2011 (38:1 Md. R. 12)
History: Regulation .06 amended effective January 13, 2011 (38:1 Md. R. 12)
History: Regulation .06D amended effective January 1, 2005 (31:23 Md. R. 1655)
History: Regulation .07 amended effective January 13, 2011 (38:1 Md. R. 12)
History: Regulation .08 adopted effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)