CarePlus members have 60 calendar days from the date of occurrence to file a formal grievance to the health plan.
Any Member who has a grievance against CarePlus or its providers for any matter may submit an oral or a written statement of the grievance to CarePlus. A grievance form may be requested from the Member Services or the Grievance & Appeals Department. The oral or written grievance should contain the following:
a. Member’s name, and identification number,
b. Summary of occurrence,
c. Description of the relief sought;
d. The Member’s signature; and
e. The date the grievance was signed.
The written statement or Grievance Form must be forwarded to the CarePlus Grievance & Appeals Department to the following address or fax number:
CAREPLUS HEALTH PLANS, INC.
11430 NW 20th Street, Suite 300
Doral, Florida 33172
Attention: Grievance & Appeals Department
Fax: (800) 956-4288
Grievances will be resolved in accordance with the Medicare Managed Care Manual mandated by CMS.
24 hours for expedited grievances. Expedited grievances exist whenever:
The health plan extends the time frame to make an organization/coverage determination or reconsideration or redetermination; or
The health plan refuses to grant a request for an expedited organization/coverage determination, reconsideration or redetermination
30 calendar days for standard grievances. Prompt appropriate action, including a full investigation of the grievance as expeditiously as the member’s case requires, based on the member’s health status, but no later than 30 calendar days from the date the oral written request is received, unless extended as permitted under 42 CFR 422.564 (e)(2).
CarePlus member will be referred to FMQAI, Florida’s Quality Improvement Organization (QIO), should the grievance be relating to the quality of care or service from the plan or its providers. CarePlus member’s may also send inquiries or call FMQAI directly at the following:
FMQAI
5201 West Kennedy Blvd., Suite 900
Tampa, Florida 33609
(800) 844-0795
Any Member who has a grievance against CarePlus or its providers for any matter may submit an oral or a written statement of the grievance to CarePlus. A grievance form may be requested from the Member Services or the Grievance & Appeals Department. The oral or written grievance should contain the following:
a. Member’s name, and identification number,
b. Summary of occurrence,
c. Description of the relief sought;
d. The Member’s signature; and
e. The date the grievance was signed.
The written statement or Grievance Form must be forwarded to the CarePlus Grievance & Appeals Department to the following address or fax number:
CAREPLUS HEALTH PLANS, INC.
11430 NW 20th Street, Suite 300
Doral, Florida 33172
Attention: Grievance & Appeals Department
Fax: (800) 956-4288
Grievances will be resolved in accordance with the Medicare Managed Care Manual mandated by CMS.
24 hours for expedited grievances. Expedited grievances exist whenever:
The health plan extends the time frame to make an organization/coverage determination or reconsideration or redetermination; or
The health plan refuses to grant a request for an expedited organization/coverage determination, reconsideration or redetermination
30 calendar days for standard grievances. Prompt appropriate action, including a full investigation of the grievance as expeditiously as the member’s case requires, based on the member’s health status, but no later than 30 calendar days from the date the oral written request is received, unless extended as permitted under 42 CFR 422.564 (e)(2).
CarePlus member will be referred to FMQAI, Florida’s Quality Improvement Organization (QIO), should the grievance be relating to the quality of care or service from the plan or its providers. CarePlus member’s may also send inquiries or call FMQAI directly at the following:
FMQAI
5201 West Kennedy Blvd., Suite 900
Tampa, Florida 33609
(800) 844-0795
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