MEMBER’S RIGHT TO FILE A COMPLAINT, GRIEVANCE OR DHS HEARING
Members must be informed of their right to file a complaint, grievance, or DHS Fair Hearing, as well as any changes to those rights. Providers are responsible for assisting the member in filing a complaint, grievance, or DHS Fair Hearing and ensuring they have a basic understanding of the process. 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 is provided on the Member Contacts page of this website.
A training outlining what to expect from Carelon if a complaint is filed against your organization is available on the Provider Training page under the Quality Management section. For a detailed description of the complaint, grievance, and fair hearing processes, please refer to Appendix AA and Appendix H.