# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 12 — Uniform Consultation Referral

**Authority:** Insurance Article, §§2-109 and 15-120, Annotated Code of Maryland

**Administrative History:** Effective date: October 21, 1996 (23:21 Md. R. 1467)

**Administrative 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)

**Administrative 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)

**Administrative History:** Chapter recodified from COMAR 09.31.23 to COMAR 31.10.12 effective September 7, 1998 (25:18 Md. R. 1439)

**Administrative History:** Regulation .02B amended effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .03 amended effective January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .03A amended effective January 1, 2005 (31:23 Md. R. 1655)

**Administrative History:** Regulation .04A amended effective January 1, 2005 (31:23 Md. R. 1655)

**Administrative History:** Regulation .05 amended effective January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .06 amended effective January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .06D amended effective January 1, 2005 (31:23 Md. R. 1655)

**Administrative History:** Regulation .07 amended effective January 13, 2011 (38:1 Md. R. 12)

**Administrative History:** Regulation .08 adopted effective January 1, 2005 (31:23 Md. R. 1655); January 13, 2011 (38:1 Md. R. 12)

#### Regulation .01 Applicability and Scope.

*COMAR 31.10.12.01*

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.

*COMAR 31.10.12.02*

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.

*COMAR 31.10.12.03*

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.

*COMAR 31.10.12.04*

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.

*COMAR 31.10.12.05*

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

#### Regulation .06 General Provisions.

*COMAR 31.10.12.06*

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.

*COMAR 31.10.12.07*

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.

*COMAR 31.10.12.08*

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: