Section 3.200 - Internal Inquiry Process(1) A carrier or utilization review organization may maintain an internal inquiry process, in addition to the internal grievance process in 958 CMR 3.300 through 3.314.(2) The inquiry process is a process prior to the grievance process during which a carrier or utilization review organization may attempt to answer questions and/or resolve concerns communicated on behalf of an insured to the insured's satisfaction within three business days. (a) This process shall not be used for review of an adverse determination, which must be reviewed through the internal grievance process set forth in 958 CMR 3.300 through 3.314.(b) When this inquiry process fails to answer the insured's questions or resolve the insured's concerns to his or her satisfaction within three business days, the inquiry will, at the option of the insured, be subject to the internal grievance process.(3) When a carrier or utilization review organization provides an internal inquiry process, the following shall be included in that process:(a) the provision in writing to insureds of a clear, concise and complete description of the carrier's internal inquiry process;(b) a protocol to receive and address an inquiry as expeditiously as possible, and to determine whether the insured's inquiry has been resolved to the insured's satisfaction;(c) a protocol to provide written notice to an insured whose inquiry has not been explained or resolved to the insured's satisfaction within three business days of the inquiry, of the right to have the inquiry processed as an internal grievance under 958 CMR 3.300 through 3.314 at his or her option, including the rights to reduction of an oral inquiry to writing by the carrier, written acknowledgment and written resolution of the grievance as set forth in 958 CMR 3.300 through 3.314; and(d) a system for maintaining records of each inquiry communicated by an insured or on his behalf, and response thereto, for a period of two years, which records shall be subject to inspection by the Commissioner of Insurance and the Office of Patient Protection.(4) For carriers or utilization review organizations that have an internal inquiry process, the 30-day time period for written resolution of a grievance that does not require the review of medical records begins:(a) on the day immediately following the three-business day time period for processing inquiries pursuant to 958 CMR 3.200, if the inquiry has not been addressed within that period of time; or(b) on the day the insured or the insured's authorized representative, if any, notifies the carrier or utilization review organization that s/he is not satisfied with the response to an inquiry under 958 CMR 3.200.Amended by Mass Register Issue 1301, eff. 12/4/2015.Amended by Mass Register Issue 1494, eff. 4/28/2023.