Providers’ responsibilities

in the Grievance and Appeals Process

HPSM understands that many complaints arise because of a difference in perception or misunderstanding about a situation. A critical part of resolving a member complaint involves getting a provider’s perspective about the situation under review. Here is an overview of the process:

• An HPSM Grievance and Appeals Coordinator will contact you if a member files a complaint related to services that you provided
• We want to get your honest opinion about what transpired because we understand that there may be differences of opinion
• Requests for your perspective are not an accusation of wrong-doing: we will not assume that the member’s perspective represents the full story
• In order to meet the strict timeframes for processing a complaint, the deadline for receipt of your response will be 5 days from the date the Grievance and Appeals Coordinator sends you a request

All HPSM members have the right to file complaints

Legally, neither HPSM nor providers can discourage members from filing complaints. But beyond legal requirements, we value the grievance and appeals process because it tells us what our members think of HPSM and our providers, which is essential to improving the quality of our services.

Provider retaliation against a member filing a complaint is strictly prohibited

Examples of prohibited retaliation include:

• Terminating or threatening to terminate a member from your practice after the member has filed a complaint
  
• Refusing to provide treatment or needed prescription refills to a member because of a complaint filed
  
• Treating the member in a disrespectful, hostile, or otherwise negative manner in response to the member filing a complaint