- (a) A utilization review agent shall establish and maintain a complaint system that provides reasonable procedures for the resolution of oral or written complaints initiated by enrollees, patients, or health care providers concerning the utilization review.
- (b) The complaint procedure must include a requirement that the utilization review agent provide a written response to the complainant within 30 days.
- (c) A utilization review agent shall submit to the commissioner a summary report of all complaints at the times and in the form specified by the commissioner. The agent shall allow the commissioner to examine the complaints and relevant documents at any time.
- (d) A utilization review agent shall maintain a record of each complaint until the third anniversary of the date the complainant filed the complaint.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.