Policy and Procedure No.: 13.3 Page 2 of 4
Provider Relations will ensure that all questions, complaints and grievances are handled within the specified time periods by the appropriate section of the Office of Managed Care (OMC).
PROVIDER RELATIONS GRIEVANCE COORDINATOR
Receives question or complaint from provider in writing, in person, or by telephone and informs the provider of his/her right to file an Informal Complaint or Formal Grievance.
Note: If complaint suggests care or clinical issue, it will
a quality of be handled Grievances
as a are
forwarded resolution the same
to Medical Administration for and are processed according to time line as Formal Grievances.
Records grievance code into Informal
Interviews provider to obtain specifics of the question or complaint and attempts to resolve the issue to the provider's satisfaction.
Contacts appropriate OMC assistance with resolution,
Secfion(s) for if necessary.
Collects information from appropriate OMC Section, if required, and informs provider of resolution.
If complaint is received in person or over the telephone, Provider Relations responds orally within seven (7) calendar days.