TMPPM 2011 > Volume 1, General Information > Section 8: Managed Care > PCCM > Provider Complaints and Appeals > Conflict Resolution

   
 

8.6.20 Provider Complaints and Appeals

8.6.20.1 Conflict Resolution

The relationship between client and PCP may become unsatisfactory to one or both parties. The PCP should contact the PCCM Provider Helpline or write to request assistance in resolving the situation.

PCCM will initiate one or more of the following steps:

Contact the client and the provider to assess the situation and provide educational information that may clarify the situation, if applicable.

Refer the situation to CHS staff for education or to help clarify the situation.

Refer the situation to the Complaint Resolution Team, if applicable.

Begin complaint/grievance resolution.

Reassign the client to another PCP.


Texas Medicaid & Healthcare Partnership
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