RN/MD Review only (#E) Criteria III. Office Management Reviewer Guidelines An organized, timely referral system is clearly evident for making and tracking referrals, reviewing reports, providing/scheduling E. Procedures for timely follow-up care and filing reports in medical records. Referral informational resources are readily available for use by site referral/ consultative services personnel. Site staff can demonstrate (e.g., through”) the office referral process from beginning to end. Systems, practices “walk are established on site. and procedures used for handling referrals will vary from site to site. F. Member grievance/ At least one telephone number for filing grievances is posted on site, or is readily available upon request. Complaint forms and a copy of the grievance procedure are readily available on site, and can be provided to members promptly upon request. complaint processes are established on site. Note: A is defined as any written or oral expression of dissatisfaction and shall include any complaint, dispute, “grievance” and request for reconsideration or appeal made by an enrollee or their representative to a Plan or entity with delegated authority to resolve grievances on behalf of the Plan.
RN/MD Review only (#E) Criteria III. Office Management Reviewer Guidelines E. Procedures for timely referral/ consultative services are established on site. An organized, timely referral system is clearly evident for making and tracking referrals, reviewing reports, providing/scheduling follow-up care and filing reports in medical records. Referral informational resources are readily available for use by site personnel. Site staff can demonstrate (e.g., “walk through”) the office referral process from beginning to end. Systems, practices and procedures used for handling referrals will vary from site to site. F. Member grievance/ complaint processes are established on site. At least one telephone number for filing grievances is posted on site, or is readily available upon request. Complaint forms and a copy of the grievance procedure are readily available on site, and can be provided to members promptly upon request. Note: A “grievance” is defined as any written or oral expression of dissatisfaction and shall include any complaint, dispute, and request for reconsideration or appeal made by an enrollee or their representative to a Plan or entity with delegated authority to resolve grievances on behalf of the Plan.
MPQP1026-B.docx