Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS
Rule 120-2-58-.06 - Complaint Procedure
Current through Rules and Regulations filed through March 20, 2024
Private review agents shall establish and maintain a complaint system which includes, at a minimum, the following:
(a) Establishes and maintains a complaint system which has been approved by the Commissioner and which provides reasonable procedures for the resolution of written complaints initiated by enrollees covered persons or health care healthcare providers concerning utilization review;
(b) Maintains records of such written complaints for five years from the time the complaints are filed and submits to the Commissioner a summary report at such times and in such format as the Commissioner may require; and
(c) Permits the Commissioner to examine the complaints at any time
(d) All complaints shall be directed to the private review agent; and
(e) The private review agent shall contact the complainant, gather all pertinent facts regarding the complaint, and attempt to resolve the complaint as soon as reasonably possible within the context of written policies and procedures.
O.C.G.A. §§ 33-2-9, 33-46-1, 33-46-11.
