Practitioner/Provider Consent to Participate in Immediate Advocacy

5035.3 – Practitioner/Provider Consent to Participate in Immediate Advocacy (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) The provider and/or practitioner must also consent to Immediate Advocacy and the conditions on redisclosure. Therefore, the QIO must: 1. Contact the practitioner and/or provider to obtain oral consent to participate in Immediate Advocacy 2. Inform the provider/practitioner of the receipt of a complaint and the beneficiary’s desire to pursue resolution of the complaint through Immediate Advocacy; and 3. Convey sufficient information regarding the nature of the complaint to enable the practitioner/provider to make an informed decision about agreeing to participate in Immediate Advocacy. Immediate Advocacy is designed to be a faster resolution process, therefore the QIO should contact the practitioner and/or provider immediately after the beneficiary consents to Immediate Advocacy. Upon obtaining the practitioner/provider’s oral consent to participate in Immediate Advocacy, the QIO should follow the Immediate Advocacy procedures in §5035.4 to resolve the complaint. If the practitioner/provider opts NOT to participate in the Immediate Advocacy process, the QIO must immediately contact the beneficiary and give him/her the opportunity to file his/her complaint in writing. (See §5040 Beneficiary Complaint Review.) Practitioner/Provider is Unavailable: In some circumstances, the practitioner/provider may be unavailable for a period of time after the beneficiary consents to the use of Immediate Advocacy. In these situations, the QIO should contact the beneficiary to explain the circumstances and discuss the available options. Immediate Advocacy should not extend beyond 10 days from the initial effort to contact the practitioner/provider.