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  • SECTION 4914
    Procedures for external appeals of adverse determinations
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  • TITLE 2
    Right to External Appeal
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  • SECTION 4916
    Oversight and surveillance of the external appeal process
    • This entry was published on 2014-09-22
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    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.