Provider Web Portal Complaints. The MCO must check ODM's Provider Web portal (hereinafter referred to as HealthTrack) complaint inbox daily for updates and new complaints assigned to them. The MCO must acknowledge receipt of a HealthTrack complaint within five business days of the date the complaint was submitted by: Conducting outreach to the provider through an in-person visit, a phone call, or an email. If attempting to make contact via phone and the appropriate person is unavailable, the MCO must leave a voicemail. Outreach must include that the complaint was received and that the MCO will respond by the assigned due date; and Documenting the MCO's initial contact with the provider in HealthTrack within six business days of the submission of the complaint to include the following information: The date(s) that outreach was made to the provider (a future date of contact will not be accepted); A call reference number if applicable; The method(s) of contact; The person that made the contact; and The name of the individual(s) contacted. The MCO must perform internal research, contact the provider, and present its findings to the provider within 15 business days. Provider contact must include: Outreach Monday through Friday between the hours of 8:00 am and 5:00 pm Eastern Time; The assigned MCO provider representative's contact information; The HealthTrack complaint number or call reference number; and The MCO's findings, including all relevant information, to ensure the provider is educated on how to access all supporting policies or procedures. If the provider is non-responsive, prior to closure of the complaint, the MCO must make a minimum of three outreach attempts to the provider. The MCO must document the following in HealthTrack by the assigned due date: The date or dates that the MCO contact was made or attempted with the provider (a future date of contact will not be accepted); The method or methods of contact; The name of the individual or individuals contacted; The findings shared with the provider; The policies and procedures to support the findings; and The root cause analysis or CPSE details. If already reported to ODM as a CPSE then the MCO must include the report month and row number. If the MCO requires additional time to research a provider complaint, the MCO must: Contact the provider, advise the provider of the delay in response, and indicate that the MCO will ask ODM to grant an extension. ODM will not grant the MCO an extension if the request does not include evidence that the MCO contacted the provider; and Document the MCO's outreach to the provider in HealthTrack, including the date of the provider contact, the name(s) of the individual(s) contacted, the requested extension date, and the justification for the delay in resolution. ODM may shorten the timeframe for the MCO to address a complaint. If ODM shortens the timeframe, ODM will advise the MCO by entering a comment in HealthTrack.
Appears in 4 contracts
Samples: Baseline Provider Agreement, Baseline Provider Agreement, Baseline Provider Agreement
