Notice of Public Meetings on Clean Claims

Maryland has several statutes that address claims processing by health carriers. Sections 15-1003, 15-1004, and 15-1005 are interrelated. Section 15-1003 requires the Commissioner to adopt uniform claims forms, including uniform standards for attachments to the uniform claims form and permissible categories of disputed claims for which additional information may be requested, by regulation. Section 15-1004 of the Insurance Article requires a carrier to accept the uniform claims forms and attachments that are permitted by regulation, and prohibits a carrier from modifying the claims form or requiring additional forms. Section 15-1005 of the Insurance Article sets forth the required actions a carrier may take upon receipt of a claim, including the requirement to pay interest if a clean claim is not paid timely. The Commissioner adopted regulations pursuant to these statutes in Code of Maryland Regulations (COMAR) 31.10.11.

A clean claim is a health insurance claim submitted by a provider that contains all of the information needed for an insurer to process and reimburse the provider without having to ask for additional information, corrections, or documentation. Clean claims are important because they allow insurers to process claims more efficiently, health care providers to be reimbursed more promptly, and patients to resolve their bills more quickly. Each state has statutes and/or regulations that define when a claim is considered clean.

In Maryland, the definition of a clean claim is provided in the Code of Maryland Regulations (COMAR 31.10.11), and can be described as 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. Whether a claim is clean or not determines the carrier’s obligations under § 15-1005 of the Insurance Article.

COMAR 31.10.11.14 requires a carrier to file semi-annual reports on claims data.

The Maryland Insurance Administration (MIA) will be holding two virtual, open meetings to gather feedback from industry stakeholders and others about the regulations governing the submission and processing of clean claims. The MIA is reviewing the procedures and documentation necessary to file a clean claim to ensure these requirements accurately meet the needs of interested parties involved in the billing process. These can be found in Title 31, Subtitle 10, Chapter 11 of the Code of Maryland Regulations (COMAR 31.10.11), and the meeting will involve a discussion of COMAR 31.10.11.010-.14, which includes the following regulations:

31.10.11.10 - Attachments to Uniform Claims Forms
31.10.11.11 - Additional Information
31.10.11.12 - Receipt of a Claim
31.10.11.13 - Disclosure
31.10.11.14 - Claims Data Filing

The first meeting will take place on July 1, and will begin with a presentation by the MIA on the current regulations. The Commissioner is seeking input from industry, consumers, and other interested parties regarding how the current set of regulations is functioning with regards to the submission and processing of clean claims and what changes might be necessary to ensure the complete submission and timely processing of clean claims in the future. Specifically, should the MIA revise the regulations specifying the permissible attachments to a claim or the situations where additional information may be requested? The Commissioner is also seeking input regarding the data that should be collected by the MIA, and how the MIA should report on that data to ensure transparency and fairness. Any proposed changes to regulations will be made public for comment. This initial meeting is to review the current regulations and gather ideas for possible revisions, which will be discussed at a second public meeting to be held on Tuesday, August 18th.

An agenda will be released prior to each meeting.

Maryland Insurance Administration (MIA) - Clean Claims Regulations Public Meetings

Evaluation of the Current Clean Claims Regulations

Wednesday, July 1, 2026, 11:30 a.m. - 12:30 p.m.

ZoomGov Link: https://maryland-insurance.zoomgov.com/j/1659861707
Dial-In: (646) 828-7666
Webinar ID: 165 986 1707
(Sign-up Date of Friday, June 26, 2026 to speak at the meeting)
AGENDA

Discussion of Proposed Changes to Clean Claims Regulations

Tuesday, August 18, 10:00 a.m. - 1:00 p.m.
(Sign-up Date of Thursday, August 13, 2026 to speak at the meeting)

The MIA will release more information about how to access the virtual hearings, instructions on how to sign-up to provide comments during the meetings, and how to submit written comments as we get closer to the date of the hearings. Please contact Matthew Weiss, Manager of Health Policy Initiatives, at [email protected], with any questions.