- A health carrier shall maintain written records to document all grievances received during a calendar year. The register shall be maintained in a manner that is reasonably clear and accessible to the commissioner.
- A request for a first level review of a grievance involving an adverse determination shall be processed in compliance with § 56-61-107 and is required to be included in the health carrier’s register.
- A request for a second level review of a grievance involving an adverse determination that may be conducted pursuant to § 56-61-108 shall be included in the health carrier’s register.
- For each grievance, the register shall contain, at a minimum, the following information:
- A general description of the reason for the grievance;
- The date the grievance was received;
- The date of each review or, if applicable, review meeting;
- The resolution at each level of the grievance, if applicable;
- The date of resolution at each level, if applicable; and
- The name of the aggrieved person for whom the grievance was filed.
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- A health carrier shall retain the register compiled for a calendar year for the shorter of five (5) years or until the commissioner has adopted a final report of an examination that contains a review of the register for such calendar year.
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- A health carrier shall submit to the commissioner, at least annually, a report in the format specified by the commissioner.
- The report shall include for each type of health benefit plan offered by the health carrier:
- The number of covered lives that fall under this chapter’s protections;
- The total number of grievances;
- The number of grievances for which a covered person and healthcare provider requested a second level voluntary grievance review pursuant to § 56-61-108;
- The number of grievances resolved at each level, if applicable, and their resolution; and
- A synopsis of actions being taken to correct problems identified.
