Maintenance of Register of Written Records to Document Grievances

1. Law
2. Tennessee Code
3. Insurance
4. Tennessee Health Carrier Grievance and External Review Procedure Act
5. Maintenance of Register of Written Records to Document Grievances

1. A health carrier shall maintain written records to document all grievances received during a calendar year. The register shall be maintained in a manner that is reasonably clear and accessible to the commissioner.
2. A request for a first level review of a grievance involving an adverse determination shall be processed in compliance with § 56-61-107 and is required to be included in the health carrier's register.
3. A request for a second level review of a grievance involving an adverse determination that may be conducted pursuant to § 56-61-108 shall be included in the health carrier's register.
4. For each grievance, the register shall contain, at a minimum, the following information:
   1. A general description of the reason for the grievance;
   2. The date the grievance was received;
   3. The date of each review or, if applicable, review meeting;
   4. The resolution at each level of the grievance, if applicable;
   5. The date of resolution at each level, if applicable; and
   6. The name of the aggrieved person for whom the grievance was filed.
5. 1. A health carrier shall retain the register compiled for a calendar year for the shorter of five (5) years or until the commissioner has adopted a final report of an examination that contains a review of the register for such calendar year.
   2. 1. A health carrier shall submit to the commissioner, at least annually, a report in the format specified by the commissioner.
      2. The report shall include for each type of health benefit plan offered by the health carrier:
         1. The number of covered lives that fall under this chapter's protections;
         2. The total number of grievances;
         3. The number of grievances for which a covered person and healthcare provider requested a second level voluntary grievance review pursuant to § 56-61-108;
         4. The number of grievances resolved at each level, if applicable, and their resolution; and
         5. A synopsis of actions being taken to correct problems identified.

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