Health Insurance - Third-Party Administrators - Verification of Eligibility

HB 1464 requires health insurance companies (referred to as "carriers" or "third-party administrators") to create a simple, timely process for healthcare providers to verify if a patient is eligible for covered services before treatment. If a provider uses this process and receives confirmation of eligibility, the insurer cannot later retroactively deny payment for that service, even if the patient was ultimately ineligible. The bill also sets strict time limits for retroactive denials (6 months for most cases, 18 months for coordination with other insurers) and mandates written explanations for denials. This directly affects healthcare providers (like clinics and hospitals) and insurers in Maryland by reducing billing disputes and payment delays.