Reporting Form for Adverse Decisions and Grievances Pursuant to Maryland Insurance Article §15-10A-06
WHO NEEDS TO FILE?
As required by Maryland law, insurance carriers licensed to sell health insurance in this state must
provide an accounting of the adverse decisions issued by their company and the disposition of any
ensuing grievance filed by the member appealing that decision. This accounting will be submitted
quarterly to the Maryland Insurance Administration on the form entitled "Reporting Form for Maryland
Insurance Code §15-10A-06." All carriers that conduct utilization review must be registered as a
Private Review Agent or must delegate this responsibility to an entity that is registered as a Private
Review Agent with the Maryland Insurance Administration.
The specific statutory requirements of the report are set forth in §15-10A-06 of the Insurance Article.
Statutes can be found via the General Assembly's website,
www.mlis.state.md.us, using the link for Maryland
WHEN TO FILE?
Reports are to be submitted on a quarterly basis within 30 days of the end of the following reporting
| Report Quarter
| 1st Q — First Quarter
||January 1 — March 31
| 2nd Q — Second Quarter
||April 1 — June 30
| 3rd Q — Third Quarter
||July 1 — September 30
| 4th Q — Fourth Quarter
||October 1 — December 31
HOW TO FILE?
FAILURE TO TIMELY FILE YOUR REPORT WILL RESULT IN
DENTAL ONLY CARRIERS: If your company only provides coverage for dental services, and you are not
reporting denials for any medical procedures, then you should use the CDT code published by the ADA
instead of the ICD or CPT codes.
Note: For people who may use a scroll wheel on their mouse, please make sure you are aware of what
data field your cursor is in when scrolling. Certain fields with multiple selections can be changed by
scrolling through the options while that field is selected. If you want to scroll through the whole page,
make sure no data field is selected.
All companies have the option of filing their required report electronically within 30 days of the end of
the following reporting periods. All carriers that have filed reports in the past will be sent a user ID
and password via electronic mail. If you have not received this information, please email
AGCarrier.email@example.com or contact us at 410-468-2275.
Each user ID and password are unique. You may not use the user ID and password of one company to file on
behalf of another. You should print the report for your records as well as the confirmation sheet.