Delaware Administrative Code
Title 18 - Insurance
1300 - Health Insurance General Provisions
1315 - Arbitration of Health Insurance Disputes Between Individuals and Carriers
Section 1315-4.0 - Carrier Recordkeeping and Reporting Requirements
Universal Citation: 18 DE Admin Code 1315-4.0
Current through Register Vol. 28, No. 3, September 1, 2024
4.1 A carrier shall maintain written or electronic records documenting all grievances and Petitions for Arbitration including, at a minimum, the following information:
4.1.1 For each grievance:
4.1.1.1 The date received;
4.1.1.2 Name and plan identification number of the covered person on whose behalf the grievance was filed;
4.1.1.3 A general description of the reason for the grievance; and
4.1.1.4 The date and description of the final coverage decision.
4.1.2 For each Petition for Arbitration:
4.1.2.1 The date the Petition was filed;
4.1.2.2 Name and plan identification number of the covered person on whose behalf the Petition was filed;
4.1.2.3 A general description of the reason for the Petition; and
4.1.2.4 Date and description of the Arbitrator's decision or other disposition of the Petition.
4.2 A carrier shall file with its annual report to the Department the following information:
4.2.1 The total number grievances filed.
4.2.2 The total number of Petitions for Arbitration filed, with a breakdown showing:
4.2.2.1 The total number of final coverage decisions upheld through arbitration; and
4.2.2.2 The total number of final coverage decisions reversed through arbitration.
Disclaimer: These regulations may not be the most recent version. Delaware may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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