6.6.8915    ENROLLEE COMPLAINT SYSTEM

(1) The health carrier shall have an internal complaint system for enrollees. Such a system shall comply with the requirements of 33-31-303, MCA.

(2) The health carrier shall conduct ongoing evaluations of all enrollee complaints, including complaints about the health carrier's services filed with participating providers. Ongoing evaluations must be conducted in accordance with ARM 6.6.8910. The data on complaints must be reported and evaluated by the health carrier at least quarterly.

(3) Evaluation methods must permit the health carrier to track specific complaints, assess trends, and establish that corrective action is implemented and effective in improving the identified problem(s) .

(4) The health carrier shall document and monitor the effectiveness of its evaluation of the enrollee complaint system and communicate it to the involved providers, enrollees, and the commissioner upon request. The information is subject to the confidentiality requirements provided in 33-36-305, MCA.

 

History: 33-36-105, MCA; IMP, 33-36-303, MCA; NEW, 2001 MAR p. 1342, Eff. 7/20/01; TRANS, from 37.108.515, 2023 MAR p. 1403, Eff. 1/1/24; AMD, 2024 MAR p. 714, Eff. 4/13/24.