N.M. Admin. Code § 13.10.17.9 - GENERAL REQUIREMENTS REGARDING GRIEVANCE PROCEDURES
A.
Written grievance procedures
required. Every health care insurer shall establish and maintain
separate written procedures that comply with this rule to provide for the
internal review of adverse determination grievances and administrative
grievances.
B.
Divisible
grievance. If a grievance contains clearly divisible administrative and
adverse determination issues, then the health care insurer shall initiate
separate complaints for each issue with an explanation of the health care
insurer's actions contained in one acknowledgment letter.
C.
Assistance to grievants. In
those instances, where a grievant requests or expresses interest in pursuing a
grievance, the health care insurer shall assist the grievant to complete all
the forms required to pursue internal review and shall advise the grievant that
the MHCB is also available for assistance with appropriate forms and
deadlines.
D.
Retaliatory
action prohibited. No person shall be subject to retaliatory action by
the health care insurer for any reason related to a grievance.
Notes
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