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Provider Complaints, Member Grievances, and Member Appeals

CountyCare has established a system to allow members and providers to bring issues of concern to our attention. See below for additional information on provider complaints, member grievances and member appeals.

Provider Complaints

CountyCare has established a provider complaint system that allows a provider to dispute the policies, procedures, or any aspect of the administrative function. We take all complaints very seriously. We view complaints as an opportunity to improve the service we provide to our provider partners. CountyCare has designated a Provider Complaints Coordinator (PCC) to process provider complaints. Provider complaints will be thoroughly investigated. The PCC will provide a written notice of resolution to the provider within thirty days from the date of the decision.

Provider Complaints may be submitted in writing to:

CountyCare
Attention: Complaints
PO BOX 803758
Chicago, IL 60680

Or you can call Provider Services at 312-864-8200 / 855-444-1661 / 711 TTD/TTY.

Member Grievances

A member grievance is a complaint about any matter impacting a member other than a denied, reduced, or terminated service or item. The grievance process allows the member, or the member’s appointed representative (guardian, caretaker, relative, PCP or other treating physician) acting on behalf of the member, to file a grievance either verbally or in writing. CountyCare values its providers and will not take adverse action against providers who file a grievance on a member’s behalf. For additional information on how to file a grievance on behalf of a member, please see the Provider Manual.

Member Appeals

An appeal is the request for review of a denial or limited authorization of a requested service for a member. The appeals process allows the member, or the member’s appointed representative (guardian, caretaker, relative, PCP or other treating physician) acting on behalf of the member, to file an appeal either verbally or in writing. All appeals must be registered initially with CountyCare and may be appealed to the Department of Healthcare and Family Services when CountyCare’s process has been exhausted. CountyCare values its providers and will not take adverse action against providers who file an appeal on a member’s behalf. For additional information on how to file an appeal behalf of a member, please see the Provider Manual.


  

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