2017 Maryland Code
Insurance
Title 15 - Health Insurance
Subtitle 1 - General Provisions
§ 15-112.1. Carriers and credentialing intermediaries; uniform credentialing form

Universal Citation: MD Ins Code § 15-112.1 (2017)
  • (a) Definitions. --
    • (1) In this section the following words have the meanings indicated.
    • (2) (i) "Carrier" means:
      • 1. an insurer;
      • 2. a nonprofit health service plan;
      • 3. a health maintenance organization;
      • 4. a dental plan organization;
      • 5. a managed care organization; or
      • 6. any other person that provides health benefit plans subject to regulation by the State.
        • (ii) "Carrier" includes an entity that arranges a provider panel for a carrier.
    • (3) "Credentialing intermediary" means a person to whom a carrier has delegated credentialing or recredentialing authority and responsibility.
    • (4) "Health care provider" means an individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.
    • (5) "Provider panel" means the providers that contract with a carrier to provide health care services to the enrollees under a health benefit plan of the carrier.
    • (6) "Uniform credentialing form" means the form designated by the Commissioner for use by a carrier or its credentialing intermediary for credentialing and recredentialing a health care provider for participation on a provider panel.
  • (b) Application for becoming credentialed. --
    • (1) Except as provided in subsection (c) of this section, a carrier or its credentialing intermediary shall 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.
    • (2) A carrier or its credentialing intermediary shall make the uniform credentialing form available to any health care provider that is to be credentialed or recredentialed by that carrier or credentialing intermediary.
  • (c) Application for becoming credentialed -- Hospital or academic medical center. -- The requirements of subsection (b) of this section do not apply to a hospital or academic medical center that:
    • (1) is a participating provider on the carrier's provider panel; and
    • (2) acts as a credentialing intermediary for that carrier for health care practitioners that:
      • (i) participate on the carrier's provider panel; and
      • (ii) have privileges at the hospital or academic medical center.
  • (d) Penalties. -- The Commissioner may impose a penalty not to exceed $ 500 against any carrier for each violation of this section by the carrier or its credentialing intermediary.
  • (e) Regulations. --
    • (1) The Commissioner may adopt regulations to implement the provisions of this section.
    • (2) The Commissioner may designate a provider credentialing application developed by a nonprofit alliance of health plans and trade associations for an online credentialing system offered to carriers and providers as the uniform credentialing form if:
      • (i) the provider credentialing application is available to providers at no charge; and
      • (ii) use of the provider credentialing application is not conditioned on submitting the provider credentialing application to a carrier through the online credentialing system.
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