6.6.8840    MONITORING THE NETWORK

(1) The health carrier must establish methods for periodically assessing the sufficiency of the network to meet the health care needs of covered persons as well as assessing their satisfaction with services. The following must be included in this assessment:

(a) changes in volume of specialty services needed;

(b) changes in number of primary care providers needed;

(c) other changes in health care utilization that might indicate changes in the health status of covered persons;

(d) enrollee satisfaction with billing and record keeping;

(e) provider satisfaction with billing and record keeping;

(f) enrollee satisfaction with educational materials available to them;

(g) enrollee satisfaction with 24-hour access to medical advice and services;

(h) enrollee satisfaction with the referral process; and

(i) provider satisfaction with the referral process.

 

History: 33-36-105, MCA; IMP, 33-36-105, 33-36-201, MCA; NEW, 1999 MAR p. 2052, Eff. 9/24/99; TRANS, from 37.108.240, 2023 MAR p. 1401, Eff. 10/21/23.