N.J. Admin. Code § 11:24B-4.10

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-4.10 - Complaint mechanisms

(a) The contract shall contain provisions demonstrating the ODS' compliance with 11:24-3.7(b) or 11:24A-4.6(b) if addressing provider complaints, or 11:24-3.7(a) or 11:24A-4.6(a) if addressing complaints of covered persons.

(b) The contract shall specify the authority of the ODS to resolve complaints, and the carrier to be bound by the ODS' resolution of complaints when in favor of the covered person or provider.

(c) The contract shall specify the mechanism the ODS has in place to track and maintain records of complaints, including follow-up and the resolution of complaints, the duration for which records of complaints will be maintained, the data that the ODS will collect for the carrier, and the process for transferring information regarding complaints between the carrier and the ODS.

1. Complaint records shall be maintained for no less than four years.

2. The data to be collected shall be at least that information required for the carrier to submit reports to DOBI.

N.J. Admin. Code § 11:24B-4.10

Amended by R.2009 d.243, effective 8/3/2009.
See: 40 N.J.R. 6529(a), 41 N.J.R. 2965(a).
In (a), substituted "11:24A-4.6(b)" for "8:38A-4.6(b)".