Initial Offer of Review

5030.3 – Initial Offer of Review (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) After collecting the above information from the beneficiary, the QIO must: 1. Briefly review the information collected, including the concern(s) raised by the beneficiary, and ask the beneficiary if he/she has any additional information to provide. 2. Determine whether Immediate Advocacy could be used to resolve the complaint (See §5035) or if the complaint should be reviewed in accordance with the Peer Review process (See §5040 for Beneficiary Complaint Review and §§5100-5125 for General Quality of Care Reviews.) a. In making this determination, the QIO should consider the information collected (See §5030.2) from the beneficiary, including the Scope of the Complaint. (See §5030.1.) 3. If the complaint is deemed ELIGIBLE for Immediate Advocacy, the QIO must discuss the availability of Immediate Advocacy with the beneficiary and provide the beneficiary with the opportunity to ask questions about Immediate Advocacy in general. 4. If the complaint is deemed INELIGIBLE for Immediate Advocacy, the QIO must explain the Beneficiary Complaint Review Peer Review process, including the need for a written complaint, and ask the beneficiary whether he/she has any questions about the process in general. 5. The QIO should also provide information about the Beneficiary Satisfaction Survey and ask the beneficiary if he/she would like to participate in the Survey. 6. The QIO should also provide information about the Beneficiary Satisfaction Survey and ask the beneficiary if he/she would like to participate in the Survey. 7. End the call by letting the beneficiary know the immediate next steps depending on whether the beneficiary elects to pursue the complaint through Immediate Advocacy or through the Peer Review process. For the Peer Review process, this includes informing the beneficiary that the QIO will call once the signed Complaint form is received. The QIO should contact beneficiaries within one (1) business day of receiving the signed Complaint form.