Provider Grievances

Providers may submit grievances or appeals by:

All submissions must include:

  • Provider name, name of person submitting the grievance and contact information

    • Note – grievances may be submitted anonymously if there is concern of repercussion for submission

  • Description of the issue

  • Relevant documentation

  • Ideal solution to the issue

  • Signature of the provider or authorized representative

  • Date of the event or issue

Timeframe for Submissions

  • Grievances: Must be submitted within 30 calendar days of the event or issue.

  • Appeals: Must be submitted within 60 calendar days of the original decision.