X hits on this document

529 views

0 shares

0 downloads

0 comments

183 / 190

Exhibit N - Attachment V

PROVIDER GRIEVANCE FACT SHEET

COMMUNITY HEALTH PLAN GRIEVANCE PROCESS

You will receive an acknowledgment letter within five (5) calendar days from the receipt date of your grievance and a resolution letter within thirty (30) calendar days from the receipt of your grievance.

The resolution letter will include:

  • 1)

    Pertinent facts regarding your grievance

  • 2)

    Resolution or action to be taken by the plan to improve our service to our members and providers.

  • 3)

    Information regarding the State Department of Health Services and State Department of Managed

Health Care Fair Hearing process.

MEDI-CAL MANAGED CARE PROGRAM APPEAL PROCESS:

If you are dissatisfied with the plan's resolution, you have the right to submit a grievance appeal within thirty (30) days from the date of the resolution letter unless you can demonstrate reasonable cause as to why the time frame could not be met. Grievance appeals are initiated by contacting L.A. Care Health Plan (L.A. Care) at (213) 438-5407.

Within five (5) days of receipt of your grievance appeal, you will receive an acknowledgement letter with an invitation to attend a Provider Relations Subcommittee (Committee) meeting at L.A. Care. This meeting will take place within twenty-five (25) days from receipt of your appeal. You will have the opportunity to present your case to the Committee at which time a decision regarding your appeal will be rendered.

Within thirty (30) days of filing your appeal you will receive a resolution letter. If you do not feel that the grievance has been satisfactorily resolved, you may call the Department of Managed Health Care, which is responsible for regulating health plans at (800) 400-0815. The Department also has a TDD line (877) 688-9891 for the hearing impaired and speech impaired and an Internet Web Site: http//www.hmohelp.ca.gov.

HEALTHY FAMILIES PROGRAM APPEAL PROCESS:

If you are dissatisfied with the plan's resolution, you have the right to submit a grievance appeal within thirty (30) days from the date of the resolution letter unless you can demonstrate reasonable cause as to why the time frame could not be met. Grievance appeals are initiated by contacting the Office of Managed Care at (626) 299-5300 or by sending your written appeal to 1000 S. Fremont Avenue, Building A-East 2nd Floor, Alhambra, CA 91803.

Within five (5) days of receipt of your grievance appeal, you will receive an acknowledgement letter with an invitation to attend a Provider Grievance Appeals Committee meeting within twenty-five (25) days from receipt of your appeal. You will have the opportunity to present your case to the Committee at which time a decision regarding your appeal will be rendered.

Within thirty (30) days of filing your appeal you will receive a resolution letter. If you do not feel that the grievance has been satisfactorily resolved, you may call the Department of Managed Health Care, which is responsible for regulating health plans at (800) 400-0815. The Department also has a TDD line (877) 688-9891 for the hearing impaired and speech impaired and an Internet Web Site: http//www.hmohelp.ca.gov.

If you have any questions, please call the Community Health Plan, Member Services Grievance Unit at 1 (800) 475-5550.

Document info
Document views529
Page views529
Page last viewedThu Dec 08 12:28:50 UTC 2016
Pages190
Paragraphs4697
Words16946

Comments