N.M. Admin. Code § 13.10.17.9

Current through Register Vol. 35, No. 24, December 23, 2024

Section 13.10.17.9 - GENERAL REQUIREMENTS REGARDING GRIEVANCE PROCEDURES

A.Written grievance procedures required. Every health care insurer shall establish and maintain separate written procedures that comply with this rule to provide for the internal review of adverse determination grievances and administrative grievances.

B.Divisible grievance. If a grievance contains clearly divisible administrative and adverse determination issues, then the health care insurer shall initiate separate complaints for each issue with an explanation of the health care insurer's actions contained in one acknowledgment letter.

C.Assistance to grievants. In those instances, where a grievant requests or expresses interest in pursuing a grievance, the health care insurer shall assist the grievant to complete all the forms required to pursue internal review and shall advise the grievant that the MHCB is also available for assistance with appropriate forms and deadlines.

D.Retaliatory action prohibited. No person shall be subject to retaliatory action by the health care insurer for any reason related to a grievance.

N.M. Admin. Code § 13.10.17.9

Adopted by New Mexico Register, Volume XXVII, Issue 23, December 15, 2016, eff. 1/1/2017, Amended by New Mexico Register, Volume XXXV, Issue 22, November 19, 2024, eff. 11/19/2024