# COMAR Title 10 — Maryland Department of Health

## Subtitle 67 — Maryland Healthchoice Program

### Chapter 13 — Maryland Medicaid Managed Care Program: Independent Review Organization (IRO)

#### Regulation .01 Scope and Purpose.

*COMAR 10.67.13.01*

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.