Grievances (also called concerns or complaints) are defined as “an expression of dissatisfaction about matters involving the MCO or MCO Provider Network.” Grievances 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 by telephone, mail, email, Partners’ website or in person.
The Legal department assigns 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 in the Provider Manual.
If the person filing the grievance/complaints a member or someone acting on behalf of a member, 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 writing to:
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.
- On enrollment and on 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 grievances.
- Providers must publish and make available the toll free Partners’ Member and Recipients Services Line for members and family members, along with the telephone number for Disability Rights of North Carolina.
- Partners has a standardized appeal process for grievances that is outlined in the Provider Manual.
- Providers must keep documentation on all grievances received, including dates received, the issues included in the grievances, and resolution information.
- Any unresolved grievances/complaints should be referred to Partners.
If you have questions regarding this process, call 1-877-864-1454 or email Grievances@partnersbhm.org