Maryland HB1464 regulates third-party administrators and carriers to prevent retroactive denial of reimbursement to health care providers.

Maryland HB1464 mandates that third-party administrators of health benefit plans create a streamlined process for health care providers to verify an enrollee's eligibility for services. It prohibits carriers from retroactively denying reimbursement to providers who confirmed eligibility through this process, except in cases of fraud, improper coding, duplicate claims, or specific managed care organization issues. If a carrier denies reimbursement, it must provide a written statement detailing the basis for the denial.

Maryland HB1464 regulates third-party administrators and carriers to prevent retroactive denial of reimbursement to health care providers.

Maryland HB1464 mandates that third-party administrators of health benefit plans create a streamlined process for health care providers to verify an enrollee's eligibility for services. It prohibits carriers from retroactively denying reimbursement to providers who confirmed eligibility through this process, except in cases of fraud, improper coding, duplicate claims, or specific managed care organization issues. If a carrier denies reimbursement, it must provide a written statement detailing the basis for the denial.