Md. Code Regs. 31.10.19.06

Current through Register Vol. 51, No. 18, September 6, 2024

Section 31.10.19.06 - Payment of Fees

A. The carrier that is the subject of the complaint is responsible for paying the reasonable expenses for the complaint under review by the independent review organization or medical expert selected by the Commissioner.

B. The independent review organization or medical expert for each complaint under review shall:

(1) Present to the carrier:

(a) An invoice detailing the expenses incurred by the independent review organization or medical expert related to the complaint under review, and

(b) Any other information required in the event that the contract between the independent review organization or the medical expert and the Commissioner requires a flat fee; and

(2) Provide a copy of the invoice for each complaint under review to the Commissioner.

C. Payment by Carrier.

(1) A carrier shall pay the reasonable expenses of an independent review organization or medical expert related to the complaint under review directly within 30 days of receipt of an invoice.

(2) Failure by a carrier to pay an invoice from an independent review organization or medical expert for the complaint under review within 30 days of receipt shall result in the issuance of an order for payment by the Commissioner.

(3) Failure by a carrier to pay in accordance with the order for payment issued by the Commissioner shall constitute a violation of the Insurance Article and the Health-General Article, Annotated Code of Maryland, subject to penalty pursuant to Health-General Article, §19-730, Annotated Code of Maryland, and Insurance Article, § 27-305, Annotated Code of Maryland.

D. The carrier that is the subject of the complaint may not pay and an independent review organization or medical expert may not accept any compensation for the complaint under review in addition to the payment for reasonable expenses under §A of this regulation.

Md. Code Regs. 31.10.19.06

Regulations .06 adopted as an emergency provision effective January 1, 1999 (25:26 Md. R. 1917); adopted permanently effective February 22, 1999 (26:4 Md. R. 274)
Regulation .06C amended effective April 16, 2012 (39:7 Md. R. 496)