Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.18 - Denials of Coverage Based on Medical Necessity
Section 31.10.18.06 - Establishment, Filing, and Reporting of Internal Grievance Process
Universal Citation: MD Code Reg 31.10.18.06
Current through Register Vol. 51, No. 19, September 20, 2024
A. Each carrier shall establish an internal grievance process.
B. Each carrier shall:
(1) File with the Commissioner its internal grievance process not more than 30 days after the effective date of this chapter;
(2) File with the Commissioner each amendment to its internal process at least 30 days before its intended use;
(3) Include with the filing the circumstances, if any, under which the internal grievance process will be delegated to a private review agent;
(4) Include with the filing a copy of the applicable part of the policy, plan, certificate, enrollment materials, or other evidence of coverage that shows the information required under Insurance Article, § 15-10 A-02(k), Annotated Code of Maryland; and
(5) Submit to the Health Advocacy Unit the document describing the details of its internal grievance process and procedures that the carrier will send to a member, member's representative, or health care provider when the member, member's representative, or provider contacts the carrier about an adverse decision.
C. Each carrier shall submit its internal grievance process and any amendments to the Health Advocacy Unit not later than the date on which the carrier begins to use the process or amendment.
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