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CHAPTER 58-17I

GRIEVANCE PROCEDURE

58-17I-1      Definitions.
58-17I-2      Health benefit plan defined.
58-17I-3      Urgent care request defined.
58-17I-4      Register of grievances required--Information to be compiled--Maintenance.
58-17I-5      Report to director required--Contents.
58-17I-6      Grievance procedures--Filing--Certificate of compliance--Contact information.
58-17I-7      Review of adverse determination--Time for filing--Designation and notice of reviewers--Scope of review.
58-17I-8      Rights of covered person or authorized representative on review--Access to documentation.
58-17I-9      Time for decision and notice--Calculation of time periods.
58-17I-10      Procedures for providing new or additional evidence.
58-17I-11      Issuance of decision--Required contents.
58-17I-12      Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review.
58-17I-13      Transmission of necessary information for certain expedited reviews.
58-17I-14      Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests.
58-17I-15      Expedited review decision--Notification--Required contents.
58-17I-16      Promulgation of rules.


Back to Title 58