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Complaints

Incidents and Complaints Process

Incidents and complaints are to be filed by the CINICO employee who is made aware of the incident or receives the complaint immediately. In the Appendices is a copy of the Incident/Complaint Form which is to be completed and given to the General Manager. The General Manager is to review the incident/complaint and determine appropriate action. All reported incidents/complaints are to be logged. The General Manager is also required to enter the incident/complaint into the Incident Log or the Complaints Log. The Incidents Log and Complaints Log are to record the following information which is obtained from the Incidents/Complaint Form:

• Whether an Incident or Complaint. An incident is a minor occurrence that may become a complaint.
• Type of incident/complaint
• Date of receipt of the incident/complaint
• Name of person filing the incident/complaint
• Plan # the incident/complaint relates to
• CINICO ID# (if applicable)
• Description of incident/complaint
• Any action required
• Date required action to be completed

There is an alphanumeric system for the "Type of incident/complaint" (i.e. 2b) which uses the following code:

1. Complaint by Provider
2. Complaint by Insured
3. Complaint by Regulator
4. Auditor
5. Other
   1. Complaint regarding late payment.
   2. Complaint regarding denied claim.
   3. Complaint regarding partial payment.
   4. Complaint regarding non-response to communication.
   5. Complaint regarding personnel being rude or unprofessional.
   6. Complaint regarding termination of coverage.
   7. Complaint regarding telephone system.
   8. Complaint regarding marketing materials.
   9. Complaint regarding incorrect billing.
   10. Other

Last Updated: 2010-03-18