Grievance


The Grievance Process is outlined below:

  1. The grievance process begins by notifying – either verbally or in writing – a Cherokee Elder Care’ employee or contractor of your dissatisfaction with the quality of services provided.
  2. A Cherokee Elder Care staff member will discuss with and provide to you in writing the specific steps, including timeframes for response, that will be taken to resolve the participant’s grievance.
  3. You grievance will be written down and the matter will then be discussed with you. You or designated family members or an authorized representative may participate in this discussion and offer suggestions or ideas toward resolving the problem or issue. We will work on a solution to your grievance as quickly as possible.
  4. Cherokee Elder Care will continue to provide all necessary services during the grievance process.
  5. The grievance will be kept on file. The Cherokee Elder Care’ Quality Improvement Committee will review the issue identified in the grievance.
  6. We will work to investigate and resolve the grievance to the participant’s satisfaction within thirty (30) business days.
  7. If you and/or your designated representative agree with the Cherokee Elder Care’ proposed solution, the grievance will be considered resolved.
  8. If the participant and/or participant's representative is dissatisfied with the resolution they may take further action by contacting the State of Oklahoma or the Centers of Medicare and Medicaid (CMS):

    

Medicaid only:

Oklahoma Health Care Authority

Grievance Docket Clerk Legal Division

P.O. Drawer 18497

Oklahoma City, OK  73154-0497

Fax Number: 405 530 3444

Phone Number: 405 522 7217 or 405 522 7587

Medicare:

Medicare.gov

-Claims & Appeals
 

Appeals


If Cherokee Elder Care refuses to provide or pay for a service that you feel is necessary for your health, you or your representative have the right to request an appeal of Cherokee Elder Care’ decision.

You may request an appeal if Cherokee Elder Care:

  1. Denies a Service: refuses to provide a service you have requested
  2. Reduces a Service: reduces a previously approved service you are presently receiving
  3. Denies Payment for a Service: refuses to pay for a service you have already received
  4. Does Not Act Promptly: fails to respond in the required time to a request for services or payment
  5. Disenrolls you on an involuntary basis
  6. Refuses to enroll you in the program

INTERNAL AND EXTERNAL APPEALS PROCESS

There are two types of appeals’ systems available to you:

  1. Cherokee Elder Care’ Internal Appeal Process
  2. External Medicare or Medicaid Appeals Process

How To File An Appeal

You can file an appeal if Cherokee Elder Care refuses to provide or pay for services you feel are necessary for your health. If your Personal Care Team denies a request for services or payment or reduces your services, your team will provide you written information about the denial and about how to file an appeal.

 

If Cherokee Elder Care agrees to provide the service you requested, we must authorize or provide the service as quickly as your health requires.

 

Medicaid eligible participants have a right to appeal to the State of Oklahoma at the same time you have filed an appeal with Cherokee Elder Care.

Oklahoma Health Care Authority

Grievance Docket Clerk Legal Division

P.O. Drawer 18497

Oklahoma City, OK  73154-0497

Fax Number: 405 530 3444

Phone Number: 405 522 7217 or 405 522 7587

 

Medicare eligible participants have a right to file an appeal at:

Medicare.gov

- Claims & Appeals