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https://www.caresource.com/ga/members/contact-us/medicaid/
The CareSource Office of the Ombudsman is an independent, neutral department within CareSource that serves the needs of CareSource members, providers and other stakeholders. The CareSource Office of the Ombudsman is committed to ensuring stakeholders obtain impartial resolution to …
https://www.bbb.org/us/oh/dayton/profile/hmos/caresource-0322-373
The CareSource Utilization Management (UM) team reviewed the issue and found that the approved authorization was placed on the members' inactive Member ID file as Ms. ***** noted in her complaint.
https://www.linkedin.com/jobs/view/health-partner-resolution-specialist-at-caresource-1228222733
Complete Health Partner education, compliance, and/or complaint resolution Maintain health partner Customer Relationship Management (CRM) tool and assignment of tasks for the Health Partner ...
https://www.leagle.com/decision/infdco20190312c90
Mar 11, 2019 · CareSource, Inc., Defendant, ... The Complaint asserts that "CareSource's provider directory is wholly inadequate, inaccurate, incomplete, and misleads current and prospective enrollees." ... federal question jurisdiction will exist in this case only if the Plaintiff's state law claims necessarily depend on resolution of a substantial question ...
https://www.in.gov/idoi/files/CareSource_Indiana_Inc..pdf
Resolution – A final decision made by the Plan related to the Grievance and communicated to the Member. D. POLICY It is the policy of CareSource to provide a Grievance system that shows how CareSource allows Members or their authorized representatives a forum for expressing a …
https://gateway.insurance.ohio.gov/UI/ODI.CS.Public.UI/Complaint.mvc/DisplayConsumerComplaintForm
This complaint form, all documents you send us, and any document received by our office as a result of handling your complaint may be a public record, subject to Ohio's Public Records Act. This law requires all public records to be available for inspection by anyone, upon request.
https://www.medicare.gov/claims-appeals/how-to-file-a-complaint-grievance
A complaint is about the quality of care you got or are getting. For example, you can file a complaint if you have a problem calling the plan, or you're unhappy with how a staff person at the plan treated you. You file an appeal if you have an issue with a plan's refusal to cover a service, supply, or prescription.
https://re11.ultipro.com/CAR1029/JobBoard/JobDetails.aspx?__ID=*40DCC9582FAAB2F4
Manage and conduct root cause analysis for high-level escalations that involve intensive research and resolution Manage special projects through to resolution that may involve high dollar unpaid claims, risk of state complaint, risk of provider refusing to serve CareSource member(s), or risk of not meeting compliance requirements
http://www.aetna.com/healthcare-professionals/documents-forms/provider-complaint-appeal-request.pdf
Contact Address (Where appeal/complaint resolution should be sent) Contact Phone . Contact Fax . Contact Email Address . To help Aetna review and respond to your request, please provide the following information. (This information may be found on correspondence from Aetna.) You may use this form to appeal multiple dates of service for the same ...
http://www.supremecourt.ohio.gov/rod/docs/pdf/2/2017/2017-Ohio-1193.pdf
Agreement. In 2013, Kettering filed a complaint and a motion to compel partial arbitration. CareSource responded by filing a motion to compel arbitration. {¶ 5} The 1987 and 2005 Agreements each contains a dispute resolution provision. Section 4.1 of the 1987 Agreement says that “to …
https://providercomplaints.ohiomh.com/
The resolution timeframes for Managed Care complaints are 2 business days for complaints involving access to care, and 15 business days for all other issues. If you have a complaint regarding Medicaid Fee For Service please call 1-800-686-1516.
https://www.checkbca.org/report/human-arc-156263107/complaints
Complaint Resolution Index (CRI) Explained The Complaint Resolution Index (CRI) is an indicator on how responsive a company is in addressing and resolving customer complaints brought to their attention by BCA. If they are considering doing business with the company, consumers can use this indicator to forecast the likelihood of having their issues addressed if a problem arises.Location: 1457 East 40th Street, Cleveland, 44103, OH
http://www.sconet.state.oh.us/rod/docs/pdf/2/2014/2014-ohio-956.pdf
According to the complaint, “CareSource obtains compensation in a set amount per beneficiary from the State of Ohio to ... KHN asserts that the “dispute resolution mechanism set forth in the 1987 Contract provides for a right of access by the provider ([KHN]) to a court of law for resolution of claims,” while the 2005 Contract provides ...
https://docs.justia.com/cases/federal/district-courts/ohio/ohsdce/3:2018cv00118/212628/15
The Complaint asserts that “CareSource’s provider directory is wholly inadequate, inaccurate, incomplete, and misleads current and prospective enrollees.” Id. at ¶ 14. Plaintiffs’ Complaint asserts state-law claims, including one for injunctive relief “requiring CareSource to develop and implement an adequate system for ensuring the ...
https://www11.anthem.com/provider/noapplication/f1/s0/t0/pw_e182206.pdf?refer=ahpmedprovider
Guide to Provider Complaints and Appeals . Based on feedback from providers, Anthem Blue Cross and Blue Shield (Anthem) is clarifying our guidelines for submitting provider complaints and appeals for disputes relating to claim payment and benefit determinations. Anthem also is introducing a checklist to assist you in submitting such requests.
https://www.buckeyehealthplan.com/members/medicaid/resources/complaints-appeals.html
At Buckeye Health Plan, we hope you are always happy with our services and providers. If you are not, we have steps for handling your concerns. Learn more.
https://ohflac.wvdhhr.org/complaint.html
Home > Complaint Submission OHFLAC FILING A COMPLAINT. The Office of Health Facility Licensure & Certification (OHFLAC) encourages complainants to try to resolve concerns first through the health care facility’s grievance process because very often this is the quickest way to address the problem.
http://www.caresourceok.com/Resource-Center/Medicare-Guide
Bi-Level Devices/Respiratory Assist Devices** For a respiratory assist device to be covered, the treating physician or healthcare provider must fully document in your medical record symptoms characteristic of sleep-associated hypoventilation, such as daytime hypersomnolence, excessive fatigue, morning headaches, cognitive dysfunction, dyspnea, etc.
https://www.linkedin.com/jobs/view/provider-operations-analyst-at-caresource-1613328552
Manage special projects through to resolution that may involve high dollar unpaid claims, risk of state complaint, risk of provider refusing to serve CareSource member(s), or risk of not meeting ...Work Location: 45401, OH
https://www.justice.gov/crt/doj-agreements-and-resolutions
May 13, 2019 · Letter of Resolution: Mohave County, Arizona Superior Court - May 11, 2015; Letter of Resolution: Hawai'i State Court - March 24, 2015; Memorandum of Agreement: New Jersey Department of Corrections (PDF)- October 15, 2014 Department of Justice Issues Letter to New Jersey Department of Corrections Regarding On-Site Visit- January 10, 2017
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