Expressing a Concern or Complaint
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A grievance is an expression of dissatisfaction about any matter other than an Action. 42CFR 438.400(b)

Action is defined as the following:

  1. The denial or limited authorization of a requested service, including the type​ or level of service.
  2. The reduction, suspension or termination of a previously authorized service.
  3. The denial, in whole or in part, of payment for a service.
  4. The failure to provide services in a timely manner, as defined by the state.
  5. The failure of Cardinal Innovations Healthcare to act within the timeframes provided in 438.408(b).
  6. For a resident of a rural area with only one Managed Care Organization, the denial of a Medicaid enrollee's request to exercise his/her right, under 42CFR.438.52(b)(2)(ii), to obtain services outside the network. 42CFR.438.400(b).

If you are not satisfied with your services, how long you may have to wait for them, or the person who delivers the service, you have the right to file a Grievance Report.


Cardinal Innovations Healthcare wants to hear from you when you have a problem. That’s the only way Cardinal Innovations Healthcare can know how things are going with the people whose care we manage. You will never receive fewer services or be retaliated against for making a complaint.

 

There are several ways to make a complaint

  1. You can bring your concerns to a person working with you or their supervisor. All of the providers in the Cardinal Innovations Healthcare Network have a grievance or complaint process. Your provider, acting on your behalf, may file a grievance with Cardinal Innovations.

  2. You can call the Cardinal Innovations Healthcare Concern Line at: 1-888-213-9687

  3. You can leave an anonymous message, but if you want a call back, you will need to leave a name and phone number. You can also tell the Concern Line any suggestions you have for improvements in services or relay compliments for considerate, helpful services.

  4. You may also call the Community Operations Department (includes Community Engagement, Member Engagement and Community Affairs) by emailing memberquestions@cardinalinnovations.org.

  5. If you want to make a complaint after regular business hours or over the weekend, you can call the Access line at 1-800-939-5911.

The person taking your complaint will enter it into the computer database. The complaint will be referred to Quality Management who will assign staff to investigate your issue. All complaints are normally resolved within 30 days.

To read about all the steps in the Grievance process, look under the Rights and Responsibilities link on the home page. The Grievance Process is also in the Member and Family Handbook >

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