This chapter provides for a complaint resolution process for disputes between managed care organizations (MCOs) and providers regarding adverse medical necessity decision made by MCOs. Pursuant to this chapter, providers that receive an adverse medical necessity decision on claims for reimbursement may submit the adverse decision for review by an Independent Review Organization (IRO) designated by the Department.

Authority: Health-General Article, §§2-104(b) and 15-103(b), Annotated Code of Maryland

Effective date: April 28, 2014 (41:8 Md. R. 471)

Regulation .08B amended effective December 31, 2018 (45:26 Md. R. 1244)

Chapter transferred from COMAR 10.09.86 effective November 1, 2019 (46:22 Md. R. 977)