Md. Code Regs. 31.16.10.03

Current through Register Vol. 51, No. 18, September 6, 2024

Section 31.16.10.03 - Complaint investigation

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.

Md. Code Regs. 31.16.10.03