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This entry was published on 2014-09-22
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SECTION 4915
Prohibited practices
Insurance (ISC) CHAPTER 28, 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:

(a) 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

(b) any other method that encourages the upholding of an adverse
determination.