N.M. Admin. Code § 13.10.16.13

Current through Register Vol. 35, No. 21, November 5, 2024

Section 13.10.16.13 - REPORTING AND COMPLIANCE

A.Provider grievance plan publication and changes. No carrier shall publish a provider grievance plan., or any amendment of a provider grievance plan., that has not been reviewed and approved by the superintendent. A provider grievance plan shall be deemed approved if the superintendent fails to expressly approve, disapprove, or object to the provider grievance plan within 60 days from submission.

B.Submission of provider grievance plan. In conjunction with the provider contract certificate, a carrier shall submit a provider grievance plan for the superintendent's review and approval. At a minimum, the provider grievance plan shall include:

(1) a description of the procedures used by the carrier to receive, review, and respond to a provider grievance;

(2) the criteria and process the carrier uses to select the persons responsible for reviewing and responding to a provider grievance;

(3) the procedures by which the carrier's governing body is informed of provider grievances and the carrier's responses; and

(4) the title of staff responsible for implementation and oversight of the provider grievance process.

C.Grievance log. A carrier shall maintain a detailed log of provider grievances and their resolutions for a period of no less than five years. The carrier shall make the log available to the superintendent upon request.

N.M. Admin. Code § 13.10.16.13

Adopted by New Mexico Register, Volume XXXIII, Issue 18, September 27, 2022, eff. 1/1/2023