Introduction to Electronic Filing
Electronic filing of Semi-Annual Claims Data is a simple process. The electronic form is user friendly and
presented in a simple survey question and answer format. Each question’s design elicits the appropriate response
and information. Some questions offer help to ensure information provided correlates to answers of other
questions.
Filers may access the electronic form from any computer that connects to the Internet after entering their MIA assigned
username and password combination. You will need to first register using the following link:
https://www.apps.insurance.maryland.gov/AccountManager/RegisterAccount.
Once a filer completes and submits a form, it is secure and available only to the Maryland Insurance Administration
(“MIA”). Once the filers submit the form, they will have the opportunity to print a copy for their records at that
time. Filers will now be able to review past filings starting with this filing going forward.
If, after submitting a form, a filer realizes that information provided was incomplete or erroneous, they must
contact MIA via email to mc_filings.mia@maryland.gov (note:
underscore between "mc" and "filings.mia") with the requested changes. If needed, a blank PDF form is available
on the website.
Completion of the form requires the name and contact information of the individual filing the report. Electronic
submission of the form to the MIA represents the contact’s understanding and agreement that he/she has the
authority to complete and file the report and that the information filed is complete and accurate to the best of
his/her knowledge in accordance with Maryland laws and regulations.
Claims Data Filing
Who must file — each organization that administers or provides reimbursement for health care
benefits on an expense-incurred basis in Maryland must review Code of Maryland Regulations ("COMAR") 31.10.11 to
determine its filing responsibilities. In general, third-party payors of health care claims in Maryland must file
claims data with the MIA semi-annually. For the purpose of this Regulation, third-party payors ("Payors") are
insurers, nonprofit health service plans, health main tenance organizations ("HMOs"), managed care organizations
("MCOs") and other entities to which another Payor has delegated any or all of its claims processing
("Delegated Agents").
When to file? — claims data filings are due to the MIA semi-annually. Payors must complete and submit
the required information by September 1 for the claims reporting period of January 1 through June 30 of the
same calendar year and by March 1 for the claims reporting period of July 1 through December 31 of the preceding
calendar year.
- When submitting the required report, the Payor must designate the reporting period by checking the box for
the appropriate claims filing report description.
- The electronic form is available for a specified period of time, which is posted on the MIA website.
The posting will announce when new filings, as well as corrected reports, may be submitted. Once the filing
period is closed, reports will not be accepted until the next period.
What to report — filers must report data on all claims for health care benefits provided under an
insurance policy, contract, plan or certificate issued or delivered in the State. Health care benefits claims
include claims incurred under medical benefit plans, dental benefit plans, prescription drug plans, vision care
plans, mental and behavioral health benefit plans, home health care plans, and Medicare Supplement plans.
What are Clean Claims — defined by COMAR 31.10.11, a Clean Claim is a health care claim
submitted by a health care provider and received by a Payor that contains all of the essential data elements
of the Uniform Claims Form and meets the uniform standards of required attachments to the Uniform Claims Form.
If a received claim does not meet this definition, it is not a Clean Claim.
A Uniform Claim Form is considered to be the CMS Form 1500 for provider services and the CMS Form UB-92 for
hospital services, or their electronic equivalents. ("CMS" means the Centers for Medicare and Medicaid Services
of the U.S. Department of Health and Human Services.) The essential data elements of a Clean Claim are identified
by:
- COMAR 31.10.11.08 for CMS Form 1500, and
- COMAR 31.10.11.09 for CMS Form UB-92
Payors may report data based on their own less stringent definitions of Clean Claims. Filers must indicate
whether they define Clean Claims according to the essential data elements of COMAR 31.10.11, or whether they
determine Clean Claims based on fewer than the essential data elements of COMAR 31.10.11.
Payor Identification Information
Filers access the Semi-Annual Claims Data Filing form via the MIA’s designated Internet address using their MIA
assigned username and password combination after they register. The Internet address will be on MIA web site to
register: https://www.apps.insurance.maryland.gov/AccountManager/RegisterAccount.
Unless instructed otherwise, Payors access the electronic form, as follows:
- Insurer (includes all payors except those listed), Health Maintenance Organization (HMO), Managed Care
Organization (MCO), Delegated Agent (submitting data for another entity) / TPA, Vision Service Plans (VSP),
Dental Benefit Plan (DPO), and Pharmacy Benefit Management (PBM) by using their MIA assigned username and password
combination.
- Payors that have not received their login information, should contact the MIA for assistance by sending an e-mail
to: mc_filings.mia@maryland.gov (note: underscore between "mc" and "filings.mia").
- Payors should identify one contact for all data filings applicable to a single FEIN number. A single contact
may file data for more than one FEIN number.