Manuale del fornitore

PROCESSO DI RECLAMO

A grievance is defined as a request by a member or member representative to have Carelon reconsider a decision solely concerning the medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered service. A provider may be involved and/or act on the member’s behalf if written authorization has been obtained from the member. This can be accomplished by filling out the Modulo di liberazione del reclamo.

Per una descrizione dettagliata del reclamo, del reclamo e dei processi di equità, fare riferimento a entrambi Appendice H. e Appendice AA.