Current through Register Vol. 48, No. 51, June 17, 2024
Part 4685.1900 - RECORDS OF COMPLAINTSSubpart 1.Record requirements.Every health maintenance organization shall maintain a record of each complaint filed with it during the prior five years. The record must, where applicable, include:
A. the complaint or a copy of the complaint and the date of its filing;B. documentation of all informal discussions, consultations, conferences, and correspondence relative to each complaint, including the date or dates of each interaction and the outcomes of each interaction;C. a copy of the hearing or reconsideration findings given the complainant;D. a copy of the arbitrator's decision; andE. all documents that have been filed with a court relating to a complaint and all orders and judgments of a court relating to the complaint.Subp. 2.Log of complaints.A. A health maintenance organization shall keep retrievable documentation of complaints submitted to the health maintenance organization by complainants.B. The retrievable documentation must include the date the complaint was initially submitted; the name, address, and telephone number of the complainant, if provided; the enrollee's identification number; and the location of the complainant's complaint records.C. The retrievable documentation must include the following information regarding an enrollee who complains orally to the health maintenance organization: (3) telephone number, if provided to the health maintenance organization;(4) identification number;(5) nature of the grievance; and(6) dates when: (a) the enrollee complained orally;(b) the enrollee was provided the telephone number of the commissioner; and(c) the complaint form was mailed, if applicable.Statutory Authority: MS s 62D.03; 62D.04; 62D.11; 62D.20