Updates to Carrier Reporting Form for Adverse Decisions and Grievances

WES MOORE Governor ARUNA MILLER Lt. Governor BULLETIN 24-21 Date: September 6, 2024 To: Insurers, Nonprofit Health Service Plans, Health Maintenance Organizations and Dental Plan Organizations (Carriers) Re: House Bill 1337, Chapter 891, Acts of 2024: Updates to Carrier Reporting Form for Adverse Decisions and Grievances The purpose of this bulletin is to notify carriers of updates to the required Reporting Form for Adverse Decisions and Grievances under § 15-10A-06 of the Insurance Article. House Bill 1337, Chapter 891, Acts of 2024 amended § 15-10A-06, effective July 1, 2024, to revise the requirement of carriers to submit information to the Administration on a quarterly basis. Specifically, in addition to the existing requirements for carriers to report on specified activities under Title 15, Subtitle 10A of the Insurance Article, carriers must also report: (1) The number of members entitled to health care benefits under a policy, plan, or certificate issued or delivered in the State by the carrier; and (2) The number of clean claims for reimbursement processed by the carrier. The Administration directs the following with regard to the additional requirements in the amended 15-10A-06: the number of members reported under item (1) above should be based on the number of enrolled members as of the last day of the quarter being reported. Data reported under items (1) and (2) should be limited to membership and claims data for health benefit plans, as defined in § 15-10A-01(i) of the Insurance Article. The Administration has updated the required Reporting Form for Adverse Decisions and Grievances to include this information, and the updated form may be accessed on the Administration’s website at the following link: https://insurance.maryland.gov/Pages/carrier-report-filing.aspx JOY Y. HATCHETTE Acting Commissioner 200 St. Paul Place, Suite 2700, Baltimore, Maryland 21202 1-800-492-6116 TTY: 1-800-735-2258 www.insurance.maryland.gov