COMAR 31.10.11.14 Uniform Claim Forms (Clean Claims) Semi-Annual Claims Data Filing

STATE OF MARYLAND MARYLAND INSURANCE ADMINISTRATION 525 St. Paul Place, Baltimore, Maryland 21202-2272 Writer’s Direct Dial: 410-468-2235 Facsimile Number: 410-468-2204 e-mail : tcioni@mdinsurance.state.md.us BULLETIN To: Health Insurers Health Maintenance Organizations Nonprofit Health Service Plans Managed Care Organizations Third-Party Administrators Re: COMAR 31.10.11.14 Uniform Claim Forms (“Clean Claims”) Semi-Annual Claims Data Filing Date: September 16, 2002 Bulletin: Life and Health 02-18 Previously, the Maryland Insurance Administration announced regulations required by Insurance Article § 15-1003(d) that govern how third-party payors process and pay claims made by health care providers. The Notice of Final Action for COMAR 31.10.11.14 was published in the June 15, 2001 issue of the Maryland Register and set an effective date of September 7, 2001 for the regulation. Designed to expedite and simplify health claims processing and reduce disputes between providers and payors, the regulations establish uniform standards for claim submission by providers. The regulations apply to all third-party payors including health insurers, Health Maintenance Organizations (HMOs), nonprofit health service plans, Managed Care Organizations (MCOs), and third-party administrators registered under Title 8, Subtitle 3 of the Insurance Article, Annotated Code of Maryland. EACH ORGANIZATION THAT ADMINISTERS OR PROVIDES REIMBURSEMENT FOR HEALTH CARE BENEFITS ON AN EXPENSE-INCURRED BASIS IN MARYLAND MUST REVIEW THE COMPLETE TEXT OF THE REGULATIONS AND DETERMINE ITS RESPONSIBILITIES UNDER THESE REGULATIONS. PARRIS N. GLENDENING GOVERNOR KATHLEEN KENNEDY TOWNSEND LIEUTENANT GOVERNOR STEVEN B. LARSEN COMMISSIONER DONNA B. IMHOFF DEPUTY COMMISSIONER P. TODD CIONI ASSOCIATE COMMISSIONER COMPLIANCE & ENFORCEMENT Semi-Annual Claims Data Filing Under the Maryland regulations, third-party payors must report claims processing information to the Insurance Commissioner twice each year. A SEMI-ANNUAL CLAIMS DATA FILING FORM was created for this purpose. A copy of the form and its completion instructions may be found under “Insurer Services” on the MIA’s web site: www.mdinsurance.state.md.us . The first reporting period for third-party payors is for claims received January 1, 2002 through June 30, 2002. The first claims filing report was due September 1, 2002. The second claims data filing report is for the period July 1, 2002 through December 31, 2002. The second report is to be received by the Insurance Commissioner by March 1, 2003. Subsequent reports follow this semi-annual schedule for claims data collection and submission. September 1, 2002 Data Filing The Insurance Commissioner has extended the initial claims data filing deadline from September 1, 2002 to October 1, 2002. The Commissioner may impose penalties if a third-party payor submits inaccurate information, or if the required SEMI-ANNUAL CLAIMS DATA FILING FORM is not completed and submitted to the MIA by the October 1, 2002 filing deadline. Questions about this Bulletin may be directed to Thomas L. Marshall, Coordinator Compliance and Enforcement. He may be reached by phone at 410-468-2217, or by e-mail at tmarshall@mdinsurance.state.md.us. _______________________________________ P. Todd Cioni Associate Commissioner Compliance & Enforcement Ccdbull02189162.doc