Grievances
| Date: | April 19, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Transportation Providers |
| From: | HPSJ |
| Type: | Regulatory |
| Subject: | Grievances |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) requires 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 (QaaM) Department, monitors and investigates each of these member complaints (also known as grievances). The following is a reminder of this information and is applied and distributed to all providers.
Reminder
- 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.
- Providers must respond timely to HPSJ requests for responses to grievances. If providers are non-compliant, this may result in a corrective action.
We want you to be aware that 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.
If you have any questions, please contact our Quality Management Department at 209.942.6325, Monday – Friday 8:00 AM to 5:00 PM.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared.