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EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb1450*
HOUSE BILL 1450
J5 6lr2040
By: Delegate S. Johnson
Introduced and read first time: February 13, 2026
Assigned to: Health
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Coordination of Benefits – Carrier Responsibilities and 2
Retroactive Denials of Reimbursement 3
FOR the purpose of requiring, if a claim is submitted to a carrier and is subject to 4
coordination of benefits with another payor , the carrier to identify certain payors, 5
identify the amounts payable by certain payors, and coordinate benefits with certain 6
payors; altering the time period in which a carrier may retroactively deny 7
reimbursement subject to coordination of benefits with another carrier; and 8
generally relating to coordination of benefits by health insurance carriers. 9
BY adding to 10
Article – Insurance 11
Section 15–1005.1 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2025 Supplement) 14
BY repealing and reenacting, with amendments, 15
Article – Insurance 16
Section 15–1008 17
Annotated Code of Maryland 18
(2017 Replacement Volume and 2025 Supplement) 19
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
That the Laws of Maryland read as follows: 21
Article – Insurance 22
15–1005.1. 23
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(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 1
INDICATED. 2
(2) “CARRIER” HAS THE MEANING STAT ED IN § 15–1008 OF THIS 3
SUBTITLE. 4
(3) “PAYOR” MEANS A CARRIER , THE MARYLAND MEDICAL 5
ASSISTANCE PROGRAM, OR THE MEDICARE PROGRAM. 6
(B) IF A CLAIM IS SUBMITTED TO A CA RRIER AND IS SUBJECT TO 7
COORDINATION OF BENE FITS WITH ANOTHER PAYOR, THE CARRIER SHALL BE 8
RESPONSIBLE FOR: 9
(1) IDENTIFYING THE PRIMARY AND SECONDARY PAYORS; 10
(2) IDENTIFYING THE AMOUNTS PAYABLE BY EACH PAYOR; AND 11
(3) COORDINATING ITS BENEFITS WITH THE BENEFITS OF THE OTHER 12
PAYORS BY DETERMINING THE ORDER OF PAYMENT S AND ENSUR ING THAT 13
COMBINED PAYMENTS DO NOT EXCEED 100% OF THE TOTAL CLAIM. 14
(C) EACH CARRIER SHALL SUBMIT AN ANNUAL REPORT ON ITS ACTIVITIES 15
UNDER THIS SECTION T O THE COMMISSIONER IN THE FORM REQUIRED BY THE 16
COMMISSIONER. 17
15–1008. 18
(a) (1) In this section the following words have the meanings indicated. 19
(2) “Carrier” means: 20
(i) an insurer; 21
(ii) a nonprofit health service plan; 22
(iii) a health maintenance organization; 23
(iv) a dental plan organization; 24
(v) a managed care organization, as defined in § 15 –101 of the 25
Health – General Article; or 26
(vi) any other person that provides health be nefit plans subject to 27
regulation by the State. 28
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(3) “Code” means: 1
(i) the applicable current procedural terminology (CPT) code, as 2
adopted by the American Medical Association; 3
(ii) if for a dental service, the applicable code adopted by the 4
American Dental Association; or 5
(iii) another applicable code under an appropriate uniform coding 6
scheme used by a carrier in accordance with this section. 7
(4) “Coding guidelines” means those standards or procedures used or 8
applied by a payor to det ermine the most accurate and appropriate code or codes for 9
payment by the payor for a service or services. 10
(5) “Health care provider” means a person or entity licensed, certified or 11
otherwise authorized under the Health Occupations Article or the Health – General Article 12
to provide health care services. 13
(6) “Reimbursement” means payments made to a health care provider by a 14
carrier on either a fee–for–service, capitated, or premium basis. 15
(b) This section does not apply to an adjustment to reimbursement: 16
(1) made as part of an annual contracted reconciliation of a risk sharing 17
arrangement under an administrative service provider contract; or 18
(2) made as part of a two–sided incentive arrangement that complies with 19
§ 15–113 of this title. 20
(c) (1) If a carrier retroactively denies reimbursement to a health care 21
provider, the carrier: 22
(i) SUBJECT TO ITEM (II) OF THIS PARAGRAPH , MAY ONLY 23
RETROACTIVELY DENY R EIMBURSEMENT FOR SER VICES SUBJECT TO 24
COORDINATION OF BENE FITS WITH ANOTHER CARRIER DURING THE 9–MONTH 25
PERIOD AFTER THE DAT E ON WHICH THE CARRIER PAID THE HEALTH CARE 26
PROVIDER; 27
(II) may only retroactively deny reimbursement for services subject 28
to coordination of benefits with [another carrier, ] the Maryland Medical Assistance 29
Program[,] or the Medicare Program during the 18 –month period after the date that the 30
carrier paid the health care provider; and 31
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[(ii)] (III) except as provided in [item (i)] ITEMS (I) AND (II) of this 1
paragraph, may only retroactively deny reimbursement during the 6–month period after 2
the date that the carrier paid the health care provider. 3
(2) (i) A carrier that retroactively denies reimbursement to a health 4
care provider under paragraph (1) of this subsection shall provide the health care provider 5
with a written statement specifying the basis for the retroactive denial. 6
(ii) If the retroactive denial of reimbursement results from 7
coordination of benefits by a carrier that is not a managed care organization, the written 8
statement shall provide the name and address of the entity acknowledging responsibility 9
for payment of the denied claim. 10
(d) Except as provided in subsection (e) of this section, a carrier that does not 11
comply with the provisions of subsection (c) of this section may not retroactively d eny 12
reimbursement or attempt in any manner to retroactively collect reimbursement already 13
paid to a health care provider. 14
(e) (1) The provisions of subsection (c)(1) of this section do not apply if a carrier 15
retroactively denies reimbursement to a health care provider because: 16
(i) the information submitted to the carrier was fraudulent; 17
(ii) the information submitted to the carrier was improperly coded 18
and the carrier has provided to the health care provider sufficient information regarding 19
the coding guidelines used by the carrier at least 30 days prior to the date the services 20
subject to the retroactive denial were rendered; 21
(iii) the claim submitted to the carrier was a duplicate claim; or 22
(iv) for a claim submitted to a managed care organization, the claim 23
was for services provided to a Maryland Medical Assistance Program recipient during a 24
time period for which the Program has permanently retracted the capitation payment for 25
the Program recipient from the managed care organization. 26
(2) Information submitted to the carrier may be considered to be 27
improperly coded under paragraph (1) of this subsection if the information submitted to the 28
carrier by the health care provider: 29
(i) uses codes that do not conform with the coding guidelin es used 30
by the carrier applicable as of the date the service or services were rendered; or 31
(ii) does not otherwise conform with the contractual obligations of 32
the health care provider to the carrier applicable as of the date the service or services were 33
rendered. 34
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(f) If a carrier retroactively denies reimbursement for services as a result of 1
coordination of benefits under provisions of subsection (c)(1)(i) OR (II) of this section, the 2
health care provider shall have 6 months from the date of denial, u nless a carrier permits 3
a longer time period, to submit a claim for reimbursement for the service to the carrier, 4
Maryland Medical Assistance Program, or Medicare Program responsible for payment. 5
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 6
October 1, 2026. 7