Minnesota Administrative Rules

4685.1900 RECORDS OF COMPLAINTS.

Subpart 1.

Record requirements.

Every health maintenance organization shall maintain a record of each complaint filed with it during the prior five years. The record must, where applicable, include:

A.

the complaint or a copy of the complaint and the date of its filing;

B.

documentation of all informal discussions, consultations, conferences, and correspondence relative to each complaint, including the date or dates of each interaction and the outcomes of each interaction;

C.

a copy of the hearing or reconsideration findings given the complainant;

D.

a copy of the arbitrator's decision; and

E.

all documents that have been filed with a court relating to a complaint and all orders and judgments of a court relating to the complaint.

Subp. 2.

Log of complaints.

A.

A health maintenance organization shall keep retrievable documentation of complaints submitted to the health maintenance organization by complainants.

B.

The retrievable documentation must include the date the complaint was initially submitted; the name, address, and telephone number of the complainant, if provided; the enrollee's identification number; and the location of the complainant's complaint records.

C.

The retrievable documentation must include the following information regarding an enrollee who complains orally to the health maintenance organization:

(1)

name;

(2)

address;

(3)

telephone number, if provided to the health maintenance organization;

(4)

identification number;

(5)

nature of the grievance; and

(6)

dates when:

(a)

the enrollee complained orally;

(b)

the enrollee was provided the telephone number of the commissioner; and

(c)

the complaint form was mailed, if applicable.

Statutory Authority:

MS s 62D.03; 62D.04; 62D.11; 62D.20

History:

14 SR 903; 23 SR 1238

Published Electronically:

October 11, 2007