2019 Tennessee Code
Title 56 - Insurance
Chapter 61 - Tennessee Health Carrier Grievance and External Review Procedure Act
§ 56-61-105. Maintenance of register of written records to document grievances.
(a) 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.
(b) 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.
(c) 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.
(d) 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.
(e)
(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)
(A) A health carrier shall submit to the commissioner, at least annually, a report in the format specified by the commissioner.
(B) The report shall include for each type of health benefit plan offered by the health carrier:
(i) The number of covered lives that fall under this chapter's protections;
(ii) The total number of grievances;
(iii) The number of grievances for which a covered person and healthcare provider requested a second level voluntary grievance review pursuant to § 56-61-108;
(iv) The number of grievances resolved at each level, if applicable, and their resolution; and
(v) A synopsis of actions being taken to correct problems identified.
