N.M. Admin. Code § 8.308.15.9

Current through Register Vol. 36, No. 1, January 14, 2025

Section 8.308.15.9 - MCO PROVIDER GRIEVANCE

A. Upon a provider contracting with the MCO, the MCO shall provide at no cost a written description of its provider grievance policies and procedures to the provider. The MCO will notify each of its providers in writing of any changes to these policies and procedures. The description shall include:

(1) information on how the provider can file a MCO provider grievance and the MCO's resolution process;

(2) time frames for each step of the grievance process through its final resolution; and

(3) a description of how the provider's grievance is resolved.

B. A provider or its authorized representative shall have the right to file a grievance with its MCO to express dissatisfaction about any matter or aspect of the MCO's operation. The provider or representative may file the grievance either orally or in writing in accordance with its MCO's policies and procedures.

C. The MCO shall designate a specific employee as its provider grievance manager with the authority to:

(1) administer the policies, procedures and processes for resolution of a grievance; and

(2) review patterns and trends in grievances and initiate corrective action as necessary; and

(3) shall ensure that punitive or retaliatory action is not taken against any provider that files a grievance.

N.M. Admin. Code § 8.308.15.9

8.308.15.9 NMAC - Rp, 8.308.15.9 NMAC, 6-15-14, Adopted by New Mexico Register, Volume XXIX, Issue 08, April 24, 2018, eff. 5/1/2018