Provider Manual - Carelon-PA

BEHAVIORAL HEALTH ADMINISTRATIVE COMPLAINTS

Una queja administrativa es cualquier queja relevante para un proveedor, una entidad gubernamental, una institución o una organización de atención administrada que cualquier persona que no sea un miembro presenta, ya sea por escrito o verbalmente. Una Queja Administrativa no es una solicitud de retroautorización de servicio o una redeterminación de pago. Un miembro no puede iniciar una queja administrativa.

Behavioral health administrative complaints may be initiated either by telephone on the toll-free provider line at 877-615-8503 or in writing addressed to:

Carelon Health of Pennsylvania
Apartado de correos 1840
Municipio de Cranberry, PA 16066-1840
Atención Investigador de Quejas 

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Behavioral health administrative complaints may also be faxed to the Quality Management Department (855-287-8491).

Carelon-PA will document and work to resolve all administrative complaints within thirty (30) calendar days of receipt. If a complaint cannot be handled at the first point of contact, it will be assigned to a Complaint Investigator to resolve the complaint in an expedient manner. A letter outlining the resolution of the initial complaint will be sent to the complainant when the resolution of the complaint is accomplished, or within five (5) business days after the initial thirty (30) calendar days allocated for the complaint resolution, whichever comes first.