プロバイダーマニュアル

苦情処理プロセス

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 苦情処理フォーム.

苦情、苦情、および公正な審問プロセスの詳細については、両方を参照してください。 付録H そして 付録AA.