N.M. Admin. Code § 13.10.17.13 - PRELIMINARY DETERMINATION OF GRIEVANCE
Upon receipt of a grievance, a health care insurer shall first determine the type of grievance at hand.
A. If the grievance seeks review of an
adverse determination, it is an adverse determination grievance and the health
care insurer shall review the grievance in accordance with its procedures for
adverse determination grievances and the requirements of
13.10.17.14 NMAC through
13.10.17.26 NMAC 1978.
B. If the grievance is not based on an
adverse determination, it is an administrative grievance and the health care
insurer shall reconsider the decision in accordance with its procedures for
administrative grievances and the requirements of
13.10.17.27 NMAC through
13.10.17.33 NMAC.
Notes
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