Sec. 10.25.07.02. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Commission" means the Maryland Health Care Commission.

(2) "Electronic health care transactions" means health care transactions that have been approved by a nationally recognized health care standards development organization (SDO) to support health care informatics, information exchange, systems integration, and other health care applications.

(3) "Electronic Health Network (EHN)" means an entity involved in the exchange of electronic health care transactions between electronic health networks, payors, providers, vendors, or other entities.

(4) "Entity" means a partnership, firm, association, limited liability company, limited liability partnership, or a public or private corporation.

(5) "Grievance" means a written complaint or other information received by the Commission indicating that an MHCC-certified EHN may have violated one of the provisions of Regulation .09 of this chapter.

(6) Medical Care Electronic Claims Clearinghouse.

(a) "Medical care electronic claims clearinghouse" is an entity that transmits electronic health care transactions.

(b) "Medical care electronic claims clearinghouse" includes an electronic health network.

(7) "MHCC" means the Maryland Health Care Commission.

(8) "MHCC-Certified Electronic Health Network" means an entity that has received certification from the Maryland Health Care Commission.

(9) "Payor" means an entity that administers or provides reimbursement for health care benefits on an expense-incurred basis, including:

(a) A health maintenance organization issued a certificate of authority in accordance with Health-General Article, Title 19, Subtitle 7, Annotated Code of Maryland;

(b) A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with Insurance Article, Title 14, Annotated Code of Maryland;

(c) A third-party administrator registered under Insurance Article, Title 8, Subtitle 3, Annotated Code of Maryland;

(d) An entity that subcontracts with a third-party payor to provide specialty health care services including, but not limited to, a dental benefit payor, a vision benefit payor, a mental health benefit payor, and a pharmacy benefit manager; or

(e) A managed care organization that contracts with the Maryland Medical Assistance program to provide health services to Maryland Medical Assistance recipients in accordance with Health-General Article, Title 15, Subtitle 1, Annotated Code of Maryland.

(10) "Qualified accreditation or certification organization" means the Electronic Healthcare Network Accreditation Commission (EHNAC) or an organization recognized by the Executive Director that has established standards of quality for electronic health networks and accredits or certifies networks that meet those standards.