Beneficiary Complaint: Receipt of a Signed Beneficiary Complaint

5040.3 –Beneficiary Complaint: Receipt of a Signed Beneficiary Complaint Form (Rev.28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) Upon receiving the signed Medicare Quality of Care Complaint Form, the QIO should date- stamp the form and scan the form, original envelope, and/or facsimile or email and upload them to the CMS-designated case review system, so that the information is available for the appropriate QIO within one (1) business day. The QIO prepares the Beneficiary Quality of Care Complaint Initial Acknowledgement Letter to the Beneficiary (Appendix 5-2). The letter should be sent within one (1) business day from the date the QIO receives the signed Medicare Quality of Care Complaint Form. The original envelope, facsimile, or email from the beneficiary indicating the postmark/ date received should be kept with the original signed Medicare Quality of Care Complaint Form and the date of receipt in QIO records. Emailed forms or facsimiles are deemed “written.”