Billing Manual for Community Care Network Providers

First Level Complaint ProceduresMembers, or their designated representatives, may use any verbal or written means tolodge a complaint. They can call using one of Community Care’s toll-free numbers orsend their complaint in writing to their local Community Care office or to the corporateoffice:Community Care Behavioral Health Organization112 Washington PlaceOne Chatham Center, Suite 700Pittsburgh, PA 15219The Customer Service toll-free numbers, staffed 24 hours a day/seven days a weekwith staff trained to handle complaints, are listed on the HealthChoices Key ContactPage of this manual. The toll-free corporate clinical fax number is 1-888-251-0087.Community Care will offer impartial assistance at no cost to members who choose toexercise this right.Members may also seek assistance at any time during this process from multiplesources to include a community support person/advocate/family member.Personnel receiving and processing complaints will abide strictly by the CommunityCare Confidentiality policy. No Community Care provider or staff member may in anyway retaliate against a member who registers a complaint. If the complaint involvesa Community Care staff member, that individual may not participate in decisionsregarding resolution of the complaint.Immediately upon knowledge of a complaint, a Community Care staff member willdocument and log the complaint in PsychConsult MCO ® to include the followinginformation: (a) member’s name and ID number; (b) name of complainant (if otherthan member); (c) nature of the complaint and summary of the facts; (d) date andtime complaint received; (e) name of the staff member receiving the complaint; and(f) what the complainant requests as a resolution.A staff member will attempt to immediately resolve the problem by telephone within24 hours or one business day.Community Care will attempt to resolve complaints at the lowest level possible,ideally through the customer service representative.If resolution cannot be reached within 24 hours, the staff member will log thecomplaint in PsychConsult MCO ® and a complaint and grievance coordinator willcontact the provider or other party to investigate the complaint. The member ormember representative will receive written acknowledgement that a complaint hasbeen filed within five business days of Community Care’s receipt of the complaint.If the complaint is against a provider, Community Care will send that provider a copyof the complaint acknowledgment letter, outlining the member’s concern(s).The provider should then respond in writing to Community Care, addressing eachconcern in a simple and straightforward manner.Community Care will then review all information received, make a decision about thecomplaint, and propose a resolution to the member or their representative.Community Care Provider Manual | 1-888-251-CCBH | © 2012 All Rights Reserved | Page 40