Grievances (also called concerns or complaints) are defined as “an expression of dissatisfaction about matters involving the MCO or MCO Provider Network.” Grievances/complaints are expressions of dissatisfaction about any matters other than an “action” (summarized as Utilization Management Department decisions to deny, reduce, suspend or terminate any requested services).
Anyone at Partners can receive a grievance/complaint. Grievances/complaints may be submitted via telephone, mail, email, Partners’ website, or in person.
The Legal Department is responsible for assigning grievances/complaints to appropriate staff or departments for resolution. The Legal Department also tracks, monitors, and ensures that the grievance/complaint is resolved. Timelines regarding resolution are available in the Provider Operations Manual.
If the person filing the grievance/complaint is a member or recipient, or is someone acting by or on behalf of a member or recipient, and would like to request an extension to the resolution of the grievance/complaint, the request* should be submitted either in person, by calling 1-877-864-1454, or in writing to the following address:
Partners Behavioral Health Management
901 South New Hope Road
Gastonia, NC 28054
*Include the grievance/complaint reference number located at the top of the Grievance Acknowledgement letter in the request.
Please remember that:
- Any person or organization has the right and ability to bring a grievance/complaint.
- Upon enrollment and upon request, the grievance/complaint process must be shared with all enrollees and families of enrollees accordingly.
- Additionally, Providers must inform enrollees and families that they may contact Partners directly about any grievance/complaint.
- Providers must publish and make available the toll-free Partners’ Customer Services number for enrollees and family members, along with the telephone number for the Disability Rights of North Carolina.
- Partners has a standardized appeal process for grievances/complaints that is outlined in the Provider Operations Manual.
- Providers must keep documentation on all grievances/complaints received, including dates received, the issues included in the grievances/complaints, and resolution information.
- Any unresolved grievances/complaints should be referred to Partners.
If you have questions regarding this process, please call 1-877-864-1454 or email Grievances@PartnersBHM.org