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RESPONSIBiliTY

PROVIDER RELATIONS GRIEVANCE COORDINATOR

Policy and Procedure No.: 13.3 Page 3 of 4

ACTION

If complaint is received in writing, Provider Relations responds in writing within seven (7) calendar days.

If Resolved

1

Records

resolution

code

on

Informal

Complaint/Grievance

Log.

If Unresolved

1

Reclassifies as a Formal Grievance and follows procedure for Formal Grievance below.

Formal Grievance:

1

Receives Grievance from person, or by telephone.

provider

in

writing,

in

lfin person:

2. Requests provider to complete Provider Grievance Form (Attachment II). Proceeds to step 4 below.

If

by

telephone

or

in

writing:

3. Completes Provider Grievance Form on provider's behalf and attaches copy of provider's letter, if available.

4.

Records grievance code on

Informal

Complaint/Grievance

Log.

5.

Mails Acknowledgment

Letter (Attachment III)

with Grievance provider within

Fact Sheet (Attachment five (5) calendar days of

IV) to receipt

of grievance.

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