Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.49 - Pharmacy Services Administrative Organizations
Section 31.10.49.04 - Internal Appeal Procedures
Universal Citation: MD Code Reg 31.10.49.04
Current through Register Vol. 51, No. 19, September 20, 2024
A. Each PSAO subject to this chapter shall establish written procedures to investigate and resolve disputes filed against the PSAO by a contracted pharmacy.
B. The internal appeal procedures shall:
(1) Be in writing; and
(2) Contain administrative processes and safeguards designed to ensure and verify that a PSAO remits payment to a contracted pharmacy in accordance with the pharmacy services administrative contract and Maryland law, and that the contract provisions have not been applied in an arbitrary or capricious manner.
C. The procedures established by the PSAO may not require:
(1) More than one appeal before filing a complaint with the Commissioner; or
(2) The payment of a fee to file an appeal.
D. The internal appeal procedures established by the PSAO shall be provided to the Commissioner on request.
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