دليل المزود

حق العضو في تقديم شكوى أو تظلم أو جلسة استماع للوزارة

Members must be informed of their right to file a complaint, grievance, or DHS Fair Hearing, as well as any changes to those rights. You are forbidden from retaliation in any way. If a member needs additional assistance, they may contact an ombudsman in their county. All services provided by an ombudsman are free of charge and confidential. A list of telephone numbers for the ombudsman and other available support services in each County are outlined in the Directories Section in the Provider Directories page of this website: Provider Directories | Carelon Health of Pennsylvania.

When a complaint is filed, Carelon expects providers to respond to QM Process as outlined in the request within the required time frame outlined in the request. A training outlining what to expect from Carelon when a complaint is filed against your organization is available on the صفحة تدريب الموفر تحت قسم إدارة الجودة.