<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 31.10.49.04" title_num="31" subtitle_num="10" chapter_num="49" heading="Internal Appeal Procedures.">
  <paragraph num="A.">
    <text>Each PSAO subject to this chapter shall establish written procedures to investigate and resolve disputes filed against the PSAO by a contracted pharmacy.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The internal appeal procedures shall:</text>
    <paragraph num="(1)">
      <text>Be in writing; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Contain administrative processes and safeguards designed to ensure and verify that a PSAO remits payment to a contracted pharmacy in accordance with the pharmacy services administrative contract and Maryland law, and that the contract provisions have not been applied in an arbitrary or capricious manner.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>The procedures established by the PSAO may not require:</text>
    <paragraph num="(1)">
      <text>More than one appeal before filing a complaint with the Commissioner; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The payment of a fee to file an appeal.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The internal appeal procedures established by the PSAO shall be provided to the Commissioner on request.</text>
  </paragraph>
</regulation>