Update – Grievance Process
| Date: | June 4, 2021 |
| To: | Health Plan of San Joaquin Contracted Practitioners, Providers & Facilities |
| From: | Health Plan of San Joaquin |
| Subject: | Update – Grievance Process |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) and the Department of Managed Health
Care (DMHC) require Health Plan of San Joaquin (HPSJ) to monitor and investigate all member complaints regarding their medical care or delivery of that care. Further, we are required to do so in a timely manner. Members have the right to file complaints with HPSJ, DHCS or DMHC for investigation and resolution.
Health Plan of San Joaquin (HPSJ), through our Quality Management (QM) Department, monitors and investigates each of these member complaints (also known as grievances).
Update
- If a member or their representative expresses any dissatisfaction with either the plan and/or the provider, the plan will notify the member that the Quality team will review their complaint.
We want you to be aware this may lead to an influx of grievances being filed against providers. Further, providers may see increases in the need for them to furnish grievance responses.
HPSJ has an obligation to members to ensure the highest level of quality care is rendered
by participating providers. As HPSJ monitors this activity, we also work collaboratively
with our providers to identify areas of opportunity that will help enhance quality care for
our members.
Thank you very much for being our partner in the commitment to provide safe, quality care
to our members, your HPSJ patients.
If you have any questions, please contact our Quality Management Department at 209.942.6325, Monday – Friday 8:00 AM to 5:00 PM.