Some more Transportation
What jobaid should you follow for all MEDICARE transportation grievances?
KM1004470
Handling transportation grievance step 1?
Apologize for any inconvenience this may have caused and file a grievance in the CAG intent on Maestro.
Handling transportation grievance step 7?
Complete grievance in CAG intent in Maestro.
QOC complaints occur when?
Services received by member from a provider is inadequate or substandard.
Whoʻs Carol Nichols?
She handles all Medicaid grievances. Email her at Carol_Nichols@uhc.com using proper template.
Who do you email when dealing with Medicare transportation issue in Hawaii
?
Qualityassurance@modivcare.com utilizing template provided in jobaid KM1004470
Handling transportation grievance step 2?
Determine if the member is currently in need of a ride home or to a medical appt or is caling about a transportation issue that occurred in the past.
Handling transportation grievance step 8?
Document then close.
QOC complaints about non-par providers are valid if?
Yes if the benefits is offered/ covered by the plan.
Who do you email when dealing with a DSNP transportation grievance in Hawai'i?
Qualityassurance@modivcare.com using template provided in jobaid KM1004470
Ignatius called saying his driver farted on the way to his Drs appt. This is the second time this driver has done this. How do you handle the call?
Apologize to member, file the grievance and follow Wellness benefits- Transportation jobaid KM1004470
Handling transportation grievance step 3?
Was transportation vendor able to get a ride for the member?
If yes continue to step 7.
If no continue to next step.
Gertrude calls with a transportation grievance from last week. In the job aid wellness benefits- transportation, what do you do?
Apologize for grievance, offer assistance with appt rescheduling. Go to step 5.
Amadeus is disappointed with care he received at Waiʻanae Comp because Dr. Shibuya was coughing and not wearing a mask. Is this a verbal grievance or QOC?
Its quality of care due to member dissatisfied with care received from provider.
Loretta called complaining that HBP is has poor customer service, they never contact her whenever they cancel her bill payments and they always transfer her back to UHC. Is this a Medicare or Medicaid grievance?
Medicare since its dealing with HBP regarding members UCard benefits.
Sylvia called to complain that her driver showed up last week with a filthy van that had roaches & smelled funny. How do you handle this?
Follow jobaid KM1004470. Apologize for the inconvience, inform member that youʻll be sending an email to vendor to inform them of the issue so it can be avoided in the future.
Step 6-9
Handling transportation grievance step 4?
Is member stranded at doctors office or facility?
Yes, between the hours of 730am-4pm CST warm transfer to transportation escalation team.
No, continue to next step.
Barnaby calls asking if he can be reimbursed for his OOP incurred due to service failure from Modivcare. He has his receipts. What do you say?
Yes, Barnaby can be reimbursed. Members can be reimbursed for fees/penalties charged for late/missed appts.
Edna calls and she complains about a copay that Dr. Shimabukuros office charged her. Is this a QOC grievance?
No, itʻs a regular verbal grievance.
Ignatius called saying his driver farted on the way to the grocery store and didnʻt apologize nor roll down the windows. Is this a Medicaid or Medicare grievance?
Medicare, he was on the way to the grocery store.
Rufus is requesting reimbursement because he paid OOP due to service failure from Modivcare. What do you do?
Advise Rufus contact Modivcare to go thru grievance process & provide a receipt.
Handling transportation grievance step 5?
Email appropriate vendor for the issue via secure delivery.
Bertha calls and sheʻs upset because the driver was supposed to pick her up 10mins ago. What do you do?
Apologize about the inconvenience & contact Modivcare for an update.
Clementine filed a complaint that his pcps office doesnʻt have handi cap stalls and he had to park an entire block away and walk with his swollen gout foot. Is this a QOC or regular verbal grievance?
QOC due to providers office, facility doesnʻt have parking available or does not have sufficient disability access.
Sherman calls saying his HC is mean, she showed up 30 mins late to his house for his in person assessment. Is this a Medicaid or Medicare grievance?
Medicaid because its regarding his HC, which is a Medicaid benefit.
Rupert calls w/ transportation grievance & currently needs ride back home. What do you do?
Contact Modivcare & proceed to next step.
DSNP PLANS ONLY: Conference member with ride assist 866-418-9813 for a replacement ride & educate member to call Modivcare for any further issues.
Handling transportation grievance step 6?
Educate the member.
The info is being sent to our transportation team so that it can be address and avoided in the future.
May receive a call from vendor transportation company if any additional info is needed.
If member has requested callback ONLY: The UHC CSA will contact you within 10 calendar days to provider the outcome of your issue.
Handling transportation grievance step 9?
When a response is received from the transportation vendor, copy and paste the response and attach a note to the grievance intent from the original call.
Eugene complains that Longʻs Waipahu pharmacy is unsanitary & nasty. Is this a QOC grievance?
Yes only if the pharmacy is unclean and poses a health risk.
Wilbur called and said that he was on hold for nearly 30mins waiting for a representative to answer his call. Is this a Medicaid or Medicare grievance?
Depends on what type of insurance Wilbur has. If he has Medicaid, then we file a grievance with Carol Nichols. If he has DSNP or Medicare, we file grievance with CAG intent.