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<chapter num="26" heading="Uniform Credentialing Form" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter applies to all:</text>
    <paragraph num="A.">
      <text>Carriers as defined in Regulation .02B(1) of this chapter; and</text>
    </paragraph>
    <paragraph num="B.">
      <text>Credentialing intermediaries as defined in Regulation .02B(2) of this chapter.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>Carrier.</text>
        <paragraph num="(a)">
          <text>“Carrier” means:</text>
          <paragraph num="(i)">
            <text>An insurer;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>A nonprofit health service plan;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>A health maintenance organization;</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>A dental plan organization; or</text>
          </paragraph>
          <paragraph num="(v)">
            <text>Any other person that provides health benefit plans subject to regulation by the State.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(b)">
          <text>“Carrier” includes an entity that arranges a provider panel for a carrier.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>“Credentialing intermediary” means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Health benefit plan” means:</text>
        <paragraph num="(a)">
          <text>A hospital or medical policy, contract, or certificate, including those issued under multiple employer trusts or associations;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>A hospital or medical policy, contract, or certificate issued by a nonprofit health service plan;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>A health maintenance organization contract; or</text>
        </paragraph>
        <paragraph num="(d)">
          <text>A dental plan organization contract.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(4)">
        <text>“Health care provider” means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article, Annotated Code of Maryland, to provide health care services.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Provider panel” means the health care providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.</text>
      </paragraph>
      <paragraph num="(6)">
        <text>“Uniform credentialing form” means the form designated by the Insurance 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>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Uniform Credentialing Form — Carrier and Credentialing Intermediary Requirements.">
    <paragraph num="A.">
      <text>A carrier or its credentialing intermediary shall:</text>
      <paragraph num="(1)">
        <text>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; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Make the uniform credentialing form available to any health care provider that is to be credentialed or recredentialed by the carrier or credentialing intermediary.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>A carrier may not, for purposes of credentialing or recredentialing, require a health care provider to:</text>
      <paragraph num="(1)">
        <text>Modify the uniform credentialing form;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Submit additional credentialing forms;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Use any other credentialing form not designated by the Commissioner; or</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Submit any additional information not specified by the uniform credentialing form, except as stated in §F of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>A carrier may preprint the designated carrier information on the uniform credentialing form.</text>
    </paragraph>
    <paragraph num="D.">
      <text>A carrier may not deny a uniform credentialing form because the form does not include the designated carrier information of the carrier.</text>
    </paragraph>
    <paragraph num="E.">
      <text>A carrier may require a health care provider to submit a new Authorization to Release Information and Affirmation page, with an original signature and date, for the purpose of credentialing or recredentialing.</text>
    </paragraph>
    <paragraph num="F.">
      <text>A carrier that is a managed care organization may require a provider to make the disclosure required by 42 CFR §1002.3.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Electronic Filing.">
    <paragraph num="A.">
      <text>The uniform credentialing form may be obtained in an electronic format.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The uniform credentialing form may be transmitted by facsimile.</text>
    </paragraph>
    <paragraph num="C.">
      <text>A transmission by facsimile is not considered an electronic transfer for the purposes of this chapter.</text>
    </paragraph>
    <paragraph num="D.">
      <text>Capability of Electronic Filing.</text>
      <paragraph num="(1)">
        <text>The uniform credentialing form developed under this chapter shall be capable of electronic filing.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>The uniform credentialing form may be filed electronically in any format that contains the data required to be contained in the uniform credentialing form.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Effective Date.">
    <text>The regulations in this chapter are applicable for all credentialing and recredentialing forms used on or after January 1, 2008.</text>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109 and 15-112.1, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: December 25, 2000 (27:25 Md. R. 2285)</annotation>
    <annotation type="History" subtype="Administrative History">Chapter revised effective December 6, 2007 (34:24 Md. R. 2159)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03B amended effective January 20, 2014 (41:1 Md. R. 13)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03F adopted effective January 20, 2014 (41:1 Md. R. 13)</annotation>
  </annotations>
</chapter>