<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".14" citation="COMAR 31.10.11.14" title_num="31" subtitle_num="10" chapter_num="11" heading="Claims Data Filing.">
  <paragraph num="A.">
    <text>Required.</text>
    <paragraph num="(1)">
      <text>Except as provided in §B(2) of this regulation, twice each calendar year a third-party payor shall submit to the Commissioner a claims data filing that documents the payment and denial practices for claims from health care practitioners, hospitals, and other persons entitled to reimbursement of:</text>
      <paragraph num="(a)">
        <text>The third-party payor; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Each entity to which the third-party payor has delegated claims processing.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Each claims data filing required pursuant to this regulation shall include, at a minimum, data documenting:</text>
      <paragraph num="(a)">
        <text>The number of claims received;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The number of claims received that were clean claims pursuant to Regulations .08, .09, and .10 of this chapter;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Claims for which additional information was requested by the third-party payor, or the entity to which the third-party payor has delegated claims processing, pursuant to Regulation .11 of this chapter; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>As to all claims received, compliance or noncompliance with the requirements of Insurance Article, §15-1005, Annotated Code of Maryland, including timeliness of processing claims and paying interest.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Filing Deadlines.</text>
    <paragraph num="(1)">
      <text>The claim data filing shall be in the form approved by the Commissioner and shall be submitted to the Commissioner not later than:</text>
      <paragraph num="(a)">
        <text>September 1 of each year, beginning on September 1, 2002, for all claims received for the period of January 1—June 30 of the same calendar year; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>March 1 of each year, beginning on March 1, 2003, for all claims received for the period of July 1—December 31 of the preceding calendar year.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>If the Commissioner has evidence that a third-party payor, or an entity to which a third-party payor has delegated claims processing, is not in compliance with Insurance Article, §15-1003, 15-1004, or 15-1005, Annotated Code of Maryland, the Commissioner may require a third-party payor to submit a claims data filing more frequently than twice a year.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Use of Data by Commissioner. The Commissioner shall use the claims data filings to determine the general business practices of third-party payors and entities to which third-party payors have delegated claims processing pursuant to Insurance Article, §15-1005, Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Confidentiality of Information.</text>
    <paragraph num="(1)">
      <text>A claims data filing submitted to the Commissioner pursuant to this regulation is confidential commercial information pursuant to State Government Article, §10-617, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Except as provided in §D(3) of this regulation, the Commissioner shall deny inspection of a claims data filing.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>If information from a claims data filing is used as the basis for imposing interest or penalties on a third-party payor, the information shall be available for public inspection only as to the portions pertinent to the imposition of interest or penalties.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Commissioner may impose penalties if a third-party payor submits inaccurate information required by §A of this regulation, in an amount not to exceed the penalty amount set forth in Insurance Article, §4-113(d)(1), Annotated Code of Maryland.</text>
  </paragraph>
  <paragraph num="F.">
    <text>The Commissioner may act in accordance with Insurance Article, §4-113(b) or (d), Annotated Code of Maryland, if a third-party payor willfully submits inaccurate information required by §A of this regulation.</text>
  </paragraph>
</regulation>