18 Del. Admin. Code § 1315-4.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1315-4.0 - Carrier Recordkeeping and Reporting Requirements

4.1 A carrier shall maintain written or electronic records documenting all grievances and Petitions for Arbitration including, at a minimum, the following information:

4.1.1 For each grievance:

4.1.1.1 The date received;

4.1.1.2 Name and plan identification number of the covered person on whose behalf the grievance was filed;

4.1.1.3 A general description of the reason for the grievance; and

4.1.1.4 The date and description of the final coverage decision.

4.1.2 For each Petition for Arbitration:

4.1.2.1 The date the Petition was filed;

4.1.2.2 Name and plan identification number of the covered person on whose behalf the Petition was filed;

4.1.2.3 A general description of the reason for the Petition; and

4.1.2.4 Date and description of the Arbitrator's decision or other disposition of the Petition.

4.2 A carrier shall file with its annual report to the Department the following information:

4.2.1 The total number grievances filed.

4.2.2 The total number of Petitions for Arbitration filed, with a breakdown showing:

4.2.2.1 The total number of final coverage decisions upheld through arbitration; and

4.2.2.2 The total number of final coverage decisions reversed through arbitration.

18 Del. Admin. Code § 1315-4.0

21 DE Reg. 581 (1/1/2018) (Final)