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Complaint System 28 TAC §10.22

Complaint System 28 TAC §10.22. Workers’ Compensation Health Care Networks. Complaint System. Must Include: Reasonable procedures for resolving oral and written complaints Process for notice and appeal of complaint May use 90 day deadline for filing a complaint.

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Complaint System 28 TAC §10.22

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  1. Complaint System 28 TAC §10.22 Workers’ Compensation Health Care Networks

  2. Complaint System • Must Include: • Reasonable procedures for resolving oral and written complaints • Process for notice and appeal of complaint • May use 90 day deadline for filing a complaint

  3. Complaint System: Record of Complaints • Complaint information must be saved for three years from the date the complaint was received • Networks must keep complaint and appeal logs for each complaint

  4. The Network shall maintain a complaint log regarding each complaint and categorize each complaint as one or more of the following: • Quality of care or services • Accessibility and availability of services or providers • Utilization review and Retrospective review as applicable • Complaint Procedures • Health care provider contracts • Bill payment, as applicable • Fee disputes • Miscellaneous

  5. Complaints to The Department • Who- Any person may submit a complaint • The department's complaint form may be obtained at www.tdi.state.tx.us • By mail to: Texas Department of Insurance, HWCN Division, Mail Code 103-6A, P. O. Box 149104, Austin, Texas  78714-9104 • By facsimile(512) 490-1012 • By e-mailHmoNewComplaints@tdi.state.tx.us or ConsumerProtection@tdi.state.tx.us

  6. Retaliatory Action A network may not engage in any retaliatory action against a provider, an employer or employee because the provider, employer or employee or a person acting on behalf of the employer or employee has filed a complaint against the network

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