1. A. An MHCC-certified EHN shall submit electronic health care transactions information in accordance with this regulation to the State-designated HIE for public health and clinical purposes to facilitate:

   1. (1) A State health improvement program;
   2. (2) Mitigation of a public health emergency;
   3. (3) Improvement of patient safety; or
   4. (4) The participation of the State in the Center for Medicare and Medicaid Innovation’s Achieving Healthcare Efficiency through Accountable Design (AHEAD) model and any successor models.

2. B. Transactions to be Submitted.

   1. (1) An MHCC-certified EHN shall submit electronic health care transactions information for services delivered in Maryland to the State-designated HIE that consist of the following transactions:

      1. (a) Health care claim or equivalent encounter information (837P and 837I); and
      2. (b) Health plan eligibility inquiry and response (270).
   2. (2) Only the EHN that receives the transaction from or returns the transaction to the originating submitter directly is required to submit the transaction information to the State-designated HIE.
3. C. The Commission may request the submission of other electronic administrative transactions adopted by the Department of Health and Human Services.
4. D. An MHCC-certified EHN may include transactions related to pharmaceuticals covered by medical benefits with its submission under §B of this regulation if excluding that data would be burdensome.

5. E. Electronic Health Care Transactions Technical Submission Guidance.

   1. (1) In consultation with stakeholders, including Commission staff, the State-designated HIE shall develop an Electronic Health Care Transactions Technical Submission Guidance that:

      1. (a) Contains detailed technical requirements for submitting electronic health care transaction information to the State-designated HIE;
      2. (b) Provides an option for MHCC-certified EHNs to submit electronic health care transactions in a flat file; and
      3. (c) To the extent possible, utilizes industry recognized standards.

   2. (2) The State-designated HIE shall:

      1. (a) Invite all MHCC-certified EHNs and Commission staff to at least one meeting to discuss the initial development of the Electronic Health Care Transactions Technical Submission Guidance;
      2. (b) Invite all MHCC-certified EHNs and Commission staff to at least one meeting prior to making any material updates to the Electronic Health Care Transactions Technical Submission Guidance;

      3. (c) Solicit public comments on a draft copy of the initial Electronic Health Care Transactions Technical Submission Guidance, and any material updates to the guidance, by:

         1. (i) Publishing the draft guidance on its website; and
         2. (ii) Sending the draft guidance to MHCC-certified EHNs and the Commission by e-mail;
      4. (d) Accept comments on the draft Electronic Health Care Transactions Technical Submission Guidance for at least 30 days;
      5. (e) Publish a written response to any significant, substantive issues raised in comments; and
      6. (f) Consider all stakeholder feedback prior to finalizing the Electronic Health Care Transactions Technical Submission Guidance.
   3. (3) The State-designated HIE shall annually submit to Commission staff a final draft of the Electronic Health Care Transactions Technical Submission Guidance for approval, which shall not be unreasonably denied.
   4. (4) The State-designated HIE and the Commission shall publish the final, approved Electronic Health Care Transactions Technical Submission Guidance on their websites.
   5. (5) An MHCC-certified EHN shall submit electronic health care transaction information to the State-designated HIE in a manner detailed in the most recent version of the Electronic Health Care Transactions Technical Submission Guidance.

6. F. Submission Schedule.

   1. (1) No later than the last business day of each month, an MHCC-certified EHN shall submit electronic health care transactions information from the preceding month to the State-designated HIE.
   2. (2) An MHCC-certified EHN shall submit electronic health transaction information at least once per month, but may submit data more often.
7. G. An EHN may not charge a fee to a health care provider, health care payor, or the State-designated HIE for providing the information required under this regulation.

8. H. Exemptions.

   1. (1) An MHCC-certified EHN may request a 1-year exemption from certain reporting requirements in this regulation.

   2. (2) An exemption request shall:

      1. (a) Be in writing;
      2. (b) Identify each specific requirement of this regulation from which the EHN is requesting an exemption;
      3. (c) Identify the time period of the exemption, if any;
      4. (d) State the reason for each exemption request; and
      5. (e) Include information that justifies the exemption request.

   3. (3) Within 45 days after receipt of complete information from an EHN requesting an exemption, the Commission shall take one of the following actions:

      1. (a) Grant the exemption by providing written notification; or
      2. (b) Deny the exemption request by providing written notification that enumerates the reasons for the denial to the EHN.
   4. (4) The Commission may not exempt an MHCC-certified EHN from any requirement within this regulation that is otherwise required by federal or other State law.

   5. (5) The Commission may grant an exemption on the following grounds:

      1. (a) The absence of functionality in the infrastructure of the EHN that prevents the EHN from complying with the requirement;
      2. (b) The requirement would hinder the ability of the EHN to comply with other requirements of this chapter or federal or other State laws; or
      3. (c) The requirement would cause an undue burden or hardship on the EHN, such that the EHN would no longer be able to provide EHN services in the State.
   6. (6) For good cause shown, the Commission may renew a 1-year exemption for an additional 1-year period.

9. I. Effective Date.

   1. (1) The State-designated HIE shall publish the Electronic Health Care Transactions Technical Submission Guidance within 12 months of the final effective date of this regulation.
   2. (2) An MHCC-certified EHN shall begin submitting electronic health care transaction information based on the most recent version of the Electronic Health Care Transactions Technical Submission Guidance within 18 months following the initial publication of the Electronic Health Care Transactions Technical Submission Guidance.

10. J. Implementation Reporting.

    1. (1) Upon request, the State-designated HIE shall submit to the Commission updates on:

       1. (a) Its status of developing the Electronic Health Care Transactions Technical Submission Guidance;
       2. (b) Its progress in supporting MHCC-certified EHN implementation of the Electronic Health Care Transactions Technical Submission Guidance; and
       3. (c) Any disruptions or technology failures that delay implementation and associated impacts, if any.

    2. (2) An MHCC-certified EHN shall submit to the Commission at least quarterly:

       1. (a) An implementation plan and timeline detailing progress the MHCC-certified EHN has made towards submitting electronic health care transaction information to the State-designated HIE; and
       2. (b) Any other information requested by the Commission related to the implementation of this regulation.

Authority: Health-General Article, §§4-302.1, 4-302, 4-302.2—.3, 4-302.5, 19-103(c)(2), (9) and (10), 19-109(a)(1) and (8), 19-133(d), 19-134, and 19-135(a) and (b), Annotated Code of Maryland

Effective date: July 15, 1996 (23:14 Md. R. 1008)

Regulation .01 amended effective July 23, 2001 (28:14 Md. R. 1322)

Regulation .02 amended effective April 3, 2000 (27:6 Md. R. 641)

Regulation .03 amended effective July 23, 2001 (28:14 Md. R. 1322)

Regulation .05 amended effective April 15, 2002 (29:7 Md. R. 620)

Regulation .10 amended effective July 23, 2001 (28:14 Md. R. 1322)

Regulation .11 amended effective April 3, 2000 (27:6 Md. R. 641); December 23, 2002 (29:25 Md. R. 1983)

Regulations .01—.11 repealed and new Regulations .01—.11 adopted effective March 24, 2008 (35:6 Md. R. 698)

Regulation .02B amended effective December 15, 2008 (35:25 Md. R. 2150)

Regulation .02B amended as an emergency provision effective January 11, 2024 (51:3 Md. R. 152); amended permanently effective May 13, 2024 (51:9 Md. R. 440)

Regulation .04A amended effective December 15, 2008 (35:25 Md. R. 2150)

Regulation .04B amended as an emergency provision effective January 11, 2024 (51:3 Md. R. 152); amended permanently effective May 13, 2024 (51:9 Md. R. 440)

Regulation .05A amended effective December 15, 2008 (35:25 Md. R. 2150)

Regulation .05A amended as an emergency provision effective January 11, 2024 (51:3 Md. R. 152); amended permanently effective May 13, 2024 (51:9 Md. R. 440)

Regulation .06A, D amended effective December 15, 2008 (35:25 Md. R. 2150)

Regulation .09 amended as an emergency provision effective January 11, 2024 (51:3 Md. R. 152); amended permanently effective May 13, 2024 (51:9 Md. R. 440)

Regulation .09C amended effective December 15, 2008 (35:25 Md. R. 2150)

Chapter revised effective November 10, 2025 (52:22 Md. R. 1095)