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Data Capture

  • Name(s) of the customer

  • Name of patient

  • Address

  • Telephone number

  • Group number

  • Name (or initials) of individual receiving information

  • Date received

  • Type

  • Summary of issue, including who or what complaint / grievance is about

  • Source

  • Reason

  • Line of business, product line and service

  • Disposition

  • Status, e.g., forwarded to another entity, waiting for internal review

  • Resolution

  • Closed date

UNICARE will track inquiries, complaints, grievances, and appeals for reporting to regulatory entities requiring such reporting.

Tier I:

All verbal or written inquiries made by customers with respect to the provision of services by UNICARE are considered inquiries initially and categorized as Tier I issues.

Under the Tier I process, the Dental Services associate reviews the inquiry. If the determination by UNICARE made as a result of the Tier I review is satisfactory to the person requesting such review, the issue is considered closed and is not logged as a part of the complaint / grievance and appeals process.

If UNICARE’s Tier I review determination is not satisfactory to the customer requesting such review, then the associate will inform the customer that to initiate a complaint / grievance, the complaint / grievance request must be in writing. The CSR will provide the customer with the necessary form(s) and address for mailing.

Name: Title: Address:

Phone: Fax:

Barbara Chipres Manager, Compliance UNICARE (Dental Services) 5171 Verdugo Way Camarillo, CA 93012

  • (800)

    627-0004

  • (805)

    384-7531

48657

2

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