18 Del. Admin. Code § 1301-10.0
Current through Register Vol. 28, No. 5, November 1, 2024
Section 1301-10.0 - Recordkeeping and Reporting Requirements10.1 A carrier and IURO shall maintain written or electronic records for five years, after completion of the appeal process, documenting all grievances and appeals for IHCAP review including, at a minimum, the following information:10.1.1 For each grievance: 10.1.1.1 The date received;10.1.1.2 Name and plan identification number of the covered person on whose behalf the grievance was filed;10.1.1.3 A general description of the reason for the grievance; and10.1.1.4 The date and description of the final coverage decision.10.1.2 For each appeal for IHCAP review: 10.1.2.1 The date received;10.1.2.2 Name and plan identification number of the covered person on whose behalf the appeal was filed;10.1.2.3 A general description of the reason for the appeal; and10.1.2.4 Date and description of the IURO's decision or other disposition of the appeal.10.2 A carrier shall file with its annual report to the Department the following information: 10.2.1 The total number grievances filed; and10.2.2 The total number of IHCAP appeals filed, with a breakdown showing the total number of final coverage decisions:10.2.2.1 Upheld through IHCAP; and10.2.2.2 Reversed through IHCAP.10.3 A carrier shall make available to the Department upon request any of the information specified in the foregoing subsections 10.1 and 10.2 of this regulation, and other information regarding its internal review process including but not limited to the written IRP procedures and forms the carrier distributes to covered persons.10.4 An IURO shall make available to the Department upon request any of the information specified in the foregoing subsections 10.1 and 10.2 of this regulation to the extent within the IURO's records.18 Del. Admin. Code § 1301-10.0
19 DE Reg. 923 (4/1/2016)
21 DE Reg. 580 (1/1/2018)
26 DE Reg. 873 (4/1/2023) (Final)