Completing the Form

There is a sample of the electronic form at the end of these instructions. In general, the form is self-explanatory. Filers respond to a series of specific sequentially numbered questions and instructions by:

  • Entering numeric and/or alphanumeric information in the response boxes;
  • Selecting items from drop down boxes; and
  • Selecting items from a list by clicking the appropriate (radio) button.

Every question requires an answer unless otherwise noted. If the appropriate response is unknown, unavailable or not applicable to the question, the filer should enter "0" for numeric fields, or "NOT APPLICABLE" for text fields, as instructed by the question. A FORM CANNOT BE SUBMITTED IF ANSWERS ARE NOT PROVIDED FOR ONE (1) OR MORE QUESTIONS. In the event the filer attempts to submit an incomplete form, an error message will appear to list the questions needing a response. A form cannot be submitted until all errors are corrected.

Certain answers are formatted. While some questions are answered by selecting items from drop down boxes or by clicking a radio button, others require entry of numeric or text information. Numeric responses should be in integer format (e.g., 185, -220, 91250). Do not use commas or decimals (round to the appropriate whole number). Use upper case or mixed upper/lower case characters for text. Dates should be in mm/dd/yyyy format, phone numbers in xxx-xxx-xxxx format, and e-mail addresses in format.

Some responses correspond to other information provided. Survey questions are consecutively numbered (1A, 1B, 1C, 2A, 2B etc.). A second level of sequential numbering (2D.1, 2D.2, 4B.1, etc.) groups questions conceptually to help filers relate the information filed electronically to the information previously filed by paper form. Grouping also serves to relate questions for data verification. For example, Question 3A, 3B and 3C of the form concern Claims Processing Inventory. Question 3D includes a note stating: 3D= 3B+3C meaning the sum of the answers provided for questions 3B and 3C must equal the number computed in 3D. You do not need to enter this number for 3D. It will be pre-calculated based on the numbers entered in the previous 2 questions.

Some responses are subject to electronic verification. If an inappropriate response is given, the filer will receive an error message to prompt the correct answer. Error messages are displayed at the time the report is submitted. The filer must return to the corresponding question(s) and correct the error(s). (Note: in an effort to improve the filing process, the number and type of filing responses subject to electronic verification may vary and/or increase from one reporting period to another.)

An amended form may not be submitted electronically to correct data or provide additional information during a filing period. You must use the paper form to amend a report. It may be sent by email to (note: underscore between "mc" and "filings.mia") or fax to 410-468-2245. Please enter a statement in the Additional Comments area in Section 1 stating the report is an amended return. You may enter up to 500 characters.
Once the electronic form is submitted, it cannot be edited by the filer. Once a filing period is closed, reports may not be submitted until another filing period is established.

Inconsistent, incomplete or otherwise questionable filings are subject to investigation by the MIA. The MIA may contact a filer to explain certain information submitted and may require that an amended report be filed. Claims data filings also may be used by the Insurance Commissioner to determine general business practices and compliance with Insurance Article §15-1003, 15-1004 or 15-1005, Annotated Code of Maryland.

Payors may use the optional comment field at the end of the form to explain certain responses or problems encountered in completing the electronic form. For example, if the current inventory (work-in-process) reported is unusually high, the Payor may wish to explain the reasons the number appears to be inflated or inconsistent with previously reported information. Problems with form completion should also be brought to the attention of the MIA at (note: underscore between "mc" and "filings.mia").

Use a "mouse" or the keyboard "enter" and "up – down" keys to navigate the form. After the Additional Comments area in section I, you can click Save & Continue, Save only, Reset the form or just log out. You also can click on previous page in sections 2 and 3 if you need to make any changes prior to submitting your report. You will be able to print a copy of your previous submissions on the VIEW REPORT Page. This includes submitted and pending reports.

The form's design features work best when the form is accessed by using the current version of the MSN Internet Explorer or Mozilla Firefox browser. Other Internet browsers may be used. Problems experienced when accessing the form should be referred to the MIA administrator at (note: underscore between "mc" and "filings.mia").

Form Completion Terms and Tips

The following information is provided to help filers understand certain questions so that they may compile and submit accurate, meaningful data to the MIA.

Who is filing — Part 1 contains contact/payor-company information. You will need to select the payor type and FEIN, NAIC or License number to proceed. All gray areas are prepopulated. If you have no data to report and/or are reporting all zeros, click "NO" for nothing to report. Part 2 pertains to claims data while Part 3 allows you to review your submission and certify to the accuracy of your filing.

All Claims — means all Clean Claims plus all other health care claims submitted by a health care provider or covered person and received by a Payor for processing.

Claims Inventory — is the total number of claims awaiting processing comprised of pended claims and claims received but not yet paid, pended or denied. The beginning inventory of one period should equal the ending inventory of the previous report period.

Adjudicated Claims — are claims that were paid, partially paid or denied payment during the report period. The adjudication date is the date a payment or denial notice is issued (e.g., mailed) by the Payor. Question 2A must equal 2B + 2C, question 3D must equal 3B + 3C and question 4A must equal 4B.1 + 4C.1 + 4D.1 + 4E.1.

Interest Paid — is the amount of interest paid on claims not processed within 30 calendar days pursuant to Insurance Article §15-1005.

Most Prevalent Reason for the Denial of Claims — means the most frequent reason(s) a majority of claims received by a Payor are denied for payment. Payors can identify up to 5 (five) reasons for claim denials based on the frequency of their occurrence (e.g., reason #1 – BILL; reason #2 – NONCOVERED; reason #3 – COB, reason #4 – UCR, reason #5 - NOT APPLICABLE). For claims with multiple denial reason codes, indicate the primary or first denial code. To simplify data collection and promote meaningful analysis, Payors must categorize their responses to conform as best as possible to the following denial reason code list:

  1. ACCIDENT details needed from insured or provider; includes Workers Comp investigation details
  2. ADDITIONAL miscellaneous information not described by other denial reasons but is needed from patient or provider to process claim
  3. AUTHORIZATION (pre-treatment authorization) not obtained; provider referral not obtained; unauthorized services received are not covered
  4. BILL error or discrepancy; required billing information incomplete or missing
  5. COB (excepting Medicare) other coverage information needed; primary payor EOB needed
  6. DUPLICATE expense or claim received was previously considered or paid
  7. EOB (Explanation of Benefits)
  8. INELIGIBLE claimant not covered or coverage not effective at time of service
  9. MAXIMUM plan reimbursement exceeded; plan service frequency limit reached
  10. MEDICARE all Medicare issues including coordination of benefits (EOMB needed), deductible not covered or service or expense not approved by Medicare
  11. MISCELLANEOUS other reasons for denial not listed or explained by other codes
  12. NOT APPLICABLE; zero or no other denials reportable
  13. NONCOVERED expense or service; service not reimbursable due to deductible or copay/coinsurance
  14. PREEXISTING condition not covered; waiting period exclusion or limitation applies
  15. PROVIDER out-of-network, not contracted or covered; service covered by global or capitated fee or other network coverage issue
  16. TERMINATED coverage; coverage lapsed, or cancelled; dependent no longer covered; premium payments not current
  17. UCR allowable fee amount exceeded; coding problem including bundling or incidental procedure
  18. UNTIMELY filing of claim by patient or provider; exceeds plan claim filing limitation