Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 16 - MISCELLANEOUS
Chapter 31.16.10 - Complaint Investigation and Determination Process
Section 31.16.10.03 - Complaint investigation

Universal Citation: MD Code Reg 31.16.10.03

Current through Register Vol. 51, No. 19, September 20, 2024

A. Upon receipt of a complaint, the Commissioner shall begin a complaint investigation.

B. A complaint filed by a health care provider concerning a specific claim under a contract issued or delivered in Maryland by a life insurer, health insurer, nonprofit health service plan, dental plan organization, or health maintenance organization shall be considered to be filed on behalf of the individual who received the health care services for which the claim was filed, unless otherwise specified.

C. The Commissioner shall acknowledge receipt of the complaint by sending a letter or a copy of the correspondence described in §D of this regulation to the complainant and the carrier.

D. If the Commissioner determines information or documentation is needed from a carrier to conduct a complaint investigation, in accordance with Regulation .06 of this chapter:

(1) The Commissioner shall request information or documentation; and

(2) The carrier shall provide the information and documentation by the later of:
(a) 15 working days after receipt of the Commissioner's request; or

(b) The time period specified by the Commissioner in correspondence to the carrier.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.