Legislation
SECTION 4915
Prohibited practices
Public Health (PBH) CHAPTER 45, ARTICLE 49, TITLE 2
§ 4915. Prohibited practices. An external appeal agent shall not, with
respect to external appeal activities, permit or provide compensation or
anything of value to its employees, agents, or contractors based on:
1. either a percentage of the amount by which a claim is reduced for
payment or the number of claims or the cost of services for which the
person has denied authorization or payment; or
2. any other method that encourages the upholding of an adverse
determination.
respect to external appeal activities, permit or provide compensation or
anything of value to its employees, agents, or contractors based on:
1. either a percentage of the amount by which a claim is reduced for
payment or the number of claims or the cost of services for which the
person has denied authorization or payment; or
2. any other method that encourages the upholding of an adverse
determination.