PM 20-24-03: Complaints about MCOs

WAG 20-24-03.

Each Managed Care Organization (MCO) must establish and maintain a procedure for reviewing complaints by its customers or their authorized representative. The grievance may be submitted orally or in writing, using any medium, at any time. The MCO should acknowledge the receipt of the complaint within forty-eight hours and attempt to resolve the grievance as soon as possible but no later than ninety (90) days from receipt. The MCO will notify the enrollee of resolution either orally or in writing. Customers may also call the Health Benefits and All Kids Hotline at 1-800-226-0768 with MCO complaints.

• Each customer will receive a Member Handbook from their MCO. The Member Handbook details the grievance and appeals process. Customers should refer to their member handbook for more information. All Member Handbooks are posted on the plans program websites.