Beneficiary Complaint Review Overview

5025 –Beneficiary Complaint Review Overview (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) This guidance and instruction addresses the processes in completing reviews of Beneficiary Complaints. NOTE: The intake person(s) refers to qualified staff as designated by a QIO. The job title may differ within each QIO and duties may be split among different QIO staff. The guidance covers: 2. Initial intake of information that a QIO Staff Member obtains from a beneficiary. (See §§5030-5030.2). The initial intake of information includes the QIO’s determination about the type of review to be conducted—i.e., whether the complaint is appropriate for Immediate Advocacy, and if not, whether the complaint should be processed as a Beneficiary Complaint Review. 3. Immediate Advocacy process to be followed for complaints for which Immediate Advocacy has been offered and accepted. (See §§5035-5035.5.) 4. Beneficiary Complaint process and review instructions. (See §§5040-5055.7.)