Provider Handbook
SA-PIHP Grievance and Appeals System Requirements
ValueOptions of Kansas has established a grievance system including written policies and procedures that meet the following requirements:
- provides Members reasonable assistance in completing forms and other procedural steps, not limited to providing interpreter services and toll-free numbers with TTY/TDD and interpreter capability;
- acknowledges receipt of each grievance and appeal;
- ensures that decision makers on grievances and appeals were not involved in previous levels of review or decision-making and are health care professionals with clinical expertise in treating the Member’s condition or disease if any of the following apply:
- an appeal of a denial based on lack of medical necessity;
- a grievance regarding denial of expedited resolution of an appeal;
- any grievance or appeal involving clinical issues;