NY Manual
SHP Manual

SHP Provider Manual
6 Grievances, Appeals and Compliments | 6.2 Appeals

6.1 Complaints and Grievances

The regulatory definition of a grievance is any expression of dissatisfaction regarding care and treatment that does not amount to change in scope or duration of service” includes all issues previously thought of as complaints.

   •   A grievance can be written or verbal.

   •   A grievance can be filed by the member, family/caregiver, friend or provider on behalf of the member.

   •   A grievance can be made to one of the Care Management Team members (nurse, social worker or service coordinator) or any other Senior Health Partners staff member.

   •   Grievances are tracked by a formal mechanism.

   •   Attempts are made to rectify grievances immediately or within required time frames, based on the nature of the issue.

   •   The initial determination notice includes an explanation of the reasons for the decision.

   •   A member who is dissatisfied with an initial grievance determination may request a second review by filing a grievance appeal.

   •   A report of all grievances is submitted to the Department of Health on a quarterly basis.