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 31.10.18.07 - Requirements for Internal Grievance Process
Universal Citation: MD Code Reg 31.10.18.07
Current through Register Vol. 51, No. 19, September 20, 2024
An internal grievance process shall:
A. Meet the requirements established under this chapter; and
B. Include an expedited procedure for use in an emergency case for purposes of rendering a grievance decision within 24 hours after filing the grievance pursuant to the carrier's internal grievance process, that includes an explanation about:
(1) Who will make the determination whether an emergency case exists when a grievance asserts an emergency case,
(2) How the determination will be made about the existence of an emergency case,
(3) How the disclosure to the member, the member's representative, or health care provider required by Insurance Article, § 15-10 A-02(g), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists; and
(4) How the notice to the member and, if applicable, the member's representative and health care provider required by Insurance Article, § 15-10 A-02(i), Annotated Code of Maryland, will be provided when the grievance asserts that an emergency case exists.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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