Current through Acts 2023-2024, ch. 1069
Section 56-61-105 - Maintenance of register of written records to document grievances(a) A health carrier shall maintain written records to document all grievances received during a calendar year. The register shall be maintained in a manner that is reasonably clear and accessible to the commissioner.(b) A request for a first level review of a grievance involving an adverse determination shall be processed in compliance with § 56-61-107 and is required to be included in the health carrier's register.(c) A request for a second level review of a grievance involving an adverse determination that may be conducted pursuant to § 56-61-108 shall be included in the health carrier's register.(d) For each grievance, the register shall contain, at a minimum, the following information:(1) A general description of the reason for the grievance;(2) The date the grievance was received;(3) The date of each review or, if applicable, review meeting;(4) The resolution at each level of the grievance, if applicable;(5) The date of resolution at each level, if applicable; and(6) The name of the aggrieved person for whom the grievance was filed.(e)(1) A health carrier shall retain the register compiled for a calendar year for the shorter of five (5) years or until the commissioner has adopted a final report of an examination that contains a review of the register for such calendar year.(2)(A) A health carrier shall submit to the commissioner, at least annually, a report in the format specified by the commissioner.(B) The report shall include for each type of health benefit plan offered by the health carrier: (i) The number of covered lives that fall under this chapter's protections;(ii) The total number of grievances;(iii) The number of grievances for which a covered person and healthcare provider requested a second level voluntary grievance review pursuant to § 56-61-108;(iv) The number of grievances resolved at each level, if applicable, and their resolution; and(v) A synopsis of actions being taken to correct problems identified.