Md. Code Regs. 10.67.13.01
Current through Register Vol. 51, No. 25, December 13, 2024
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.
Md. Code Regs. 10.67.13.01