Reporting Form For Adverse Decisions and Grievances Pursuant To Maryland Insurance Article §15-10A-06
WHO NEEDS TO FILE?
As required by Maryland law, insurance carriers licensed to sell health insurance in this state must provide an accounting of the adverse decisions issued by their company and the disposition of any ensuing grievance filed by the member appealing that decision. This accounting will be submitted quarterly to the Maryland Insurance Administration on the form entitled "Reporting Form for Maryland Insurance Code §15-10A-06." All carriers that conduct utilization review must be registered as a Private Review Agent or must delegate this responsibility to an entity that is registered as a Private Review Agent with the Maryland Insurance Administration.
The specific statutory requirements of the report are set forth in §15-10A-06 of the Insurance Article. Statutes can be found via the General Assembly's website, www.mlis.state.md.us, using the link for Maryland Statutes.
WHEN TO FILE?
Reports are to be submitted on a quarterly basis within 15 days of the end of the following reporting periods:
|1stQ - First Quarter||1/1 - 3/31|
|2ndQ - Second Quarter||4/1 - 6/30|
|3rdQ - Third Quarter||7/1 - 9/30|
|4thQ - Fourth Quarter||10/1 - 12/31|
HOW TO FILE?
FAILURE TO TIMELY FILE YOUR REPORT WILL RESULT IN ADMINISTRATIVE PENALTIES.
DENTAL ONLY CARRIERS: If your company only provides coverage for dental services, and you are not reporting denials for any medical procedures, then you should use the CDT code published by the ADA instead of the ICD or CPT codes.
Note: The Instructions Guide below provides helpful hints and definitions
All companies have the option of filing their required report electronically. All carriers that have filed reports in the past will be sent a user ID and password in the mail. If you have not received this information, PLEASE CONTACT LOUIS BUTLER AT AGCARRIER.mia.@maryland.gov. Each user ID and password are unique. You may not file the user ID and password of one Company to file on behalf of another. You should print the report for your records as well as the confirmation sheet.