Health Care Providers

Certain uniform forms are required by the state of Maryland to be used by health care providers when submitting to insurance carriers. This section provides the requirements, instructions and the forms.

 

Uniform Credentialing

 

Image: yellow ball Uniform Credentialing Form
    October 7, 2009
    Life and Health 09-25

Image: yellow ball Maryland Uniform Credentialing Form
    This is a large file which may take some time to open. This version may be filled out, printed and saved.

Image: yellow ball CAQH Credentialing Form
    The credentialing form of CAQH may be used. 

 

 

Uniform Treatment Plan

 

Image: yellow ball Amendment to Uniform Treatment Plan Form Regulations
    March 27, 2006
    Life and Health Bulletin 06-5

Image: yellow ball Uniform Treatment Plan Instructions

Image: yellow ball Maryland Uniform Treatment Plan Form
    This is a large file which may take time to open. This version may be filled out and printed.

Image: yellow ball Maryland Uniform Dental Consultation Referral Form
    Form to be used by regulation: COMAR 31.10.12 effective 1-1-05