Provider Relations
This department must also respond to complaints made either by the providers about the members or by the members about the providers. In order to maintain a quality of service, the department conducts surveys of available office hours, numbers of appointments, and accessibility. Surveys are also conducted on member satisfaction, as well as grievances and complaints. When, for whatever reason, a provider does not meet our standards, the department, with input from the Chief Medical Officer, will work with the provider to develop and implement a corrective action plan.
Aside from distributing informational material, close contact is kept with the providers and with their staff. It is important to be sure that all providers understand the plans and that any questions they might have about claims payments, member enrollment issues or program changes are answered in a timely fashion. Any common problems with claims are also identified.






