{"data":{"id":"us-md/md.-code-insurance-15-1703","jurisdiction":"us-md","citation":"Md. Code, Insurance § 15–1703","heading":"","body":"(a) A carrier that uses a physician rating system shall:\n(1) establish an appeals process for physicians to use to contest their rating; and\n(2) at least 45 days before making available to enrollees any new or revised quality of performance or cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide each physician included in the physician rating system with:\n(i) a notice of the proposed change;\n(ii) an explanation of the data used to assess the physician and how the physician may access the data;\n(iii) the methodology and measures used to assess the physician;\n(iv) an explanation of the right to contest the rating of the physician through the appeals process of the carrier; and\n(v) instructions on how to file a timely appeal with the carrier.\n(b) If a physician files a timely appeal, as defined by the carrier, regarding the rating of the physician under a physician rating system, the carrier may not disclose the rating of the physician or make a change in the quality of performance or cost–efficiency ratings of the physician until the carrier completes its investigation and renders a decision on the appeal.\n(c) A carrier shall post the following information prominently on the section of the carrier’s Web site that discloses the rating of a physician to enrollees or to the public:\n(1) where an enrollee can find the physician performance ratings of the carrier;\n(2) a disclosure that physician performance ratings are only a guide to choosing a physician because the ratings have a risk of error and should not be the sole basis for selecting a physician;\n(3) an explanation of the physician rating system, including the basis on which physician performance is measured and the basis for determining that a physician is not currently rated due to insufficient data or a pending appeal;\n(4) any limitations of the data that the carrier uses to measure physician performance;\n(5) the factors and criteria used in the carrier’s physician rating system, including quality of performance measures and cost efficiency measures; and\n(6) how a physician may appeal a physician rating.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=15-1703","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"e06fb227b4850682060f3b2ba3e97212ada7247b4fb47f2890e925c3b752fe36","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-15-1702","next":"us-md/md.-code-insurance-15-1704"},"notice":"GroundRules: Original legal text. Not legal advice."}