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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.10 MCO/Dental Plan Appeals, Complaints, and Fair Hearings : 2.10.1 Medicaid Managed Care Complaints and Fair Hearings

Medicaid managed care providers may file complaints with HHSC if they find they did not receive full due process from the respective managed care health plan.
Appeals, grievances, or dispute resolution is the responsibility of each MCO or dental plan. Providers must exhaust the complaints or grievance process with their MCO or dental plan before filing a complaint with HHSC.
Refer to the respective MCO or dental plan for information about specific complaint policies and procedures. For NorthSTAR, see subsection 6.4, “Complaints and Appeals” in this section. For MCO appeals and fair hearing process, refer to the respective health plan’s policies and procedures. For paper appeals, refer to subsection 7.1.4, “Paper Appeals” in Section 7, “Appeals” (Vol. 1, General Information).
Once the MCO’s or dental plan’s complaints or grievance process has been exhausted, complaint requests may be sent to HHSC.
STAR, STAR+PLUS, STAR Health, and dental plan complaint requests may be emailed or mailed to HHSC:
Health and Human Services Commission
Health Plan Management
4900 N. Lamar Blvd.
MC H320
Austin, TX 78751

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.