- THCA

Volume XXX, Number 5
May 2015

MCO Complaints handled by HHSC Command Center and HPM Complaints Box

HHSC established a command center to quickly address issues resulting from the transition to managed care. The purpose of the command center is to resolve eligibility, enrollment, technical, or policy issues. For Nursing Facility implementation, the command center is comprised of HHSC and DADS staff, and it will run through May 2015. The address is ManagedCareExpansion2015 @hhsc.state.tx.us

In addition to the command center, starting March 1st and ongoing, providers serving STAR+PLUS managed care members will have access to HHSC’s Health Plan Management (HPM) complaints box. Among other things, HPM complaints handles questions related to claims adjudication, appeals, grievances, or dispute resolution.

Under managed care, providers must first exhaust the complaints or grievance process with their managed care organization (MCO) before filing a complaint with HHSC. If after completing the MCO process, the provider believes they did not receive full due process from the respective managed care health plan, they may file a complaint or inquiry at HPM_complaints @hhsc.state.tx.us

Once the transition to managed care is complete and the command center is no longer operational, the HPM complaints box will be the primary mechanism for providers and members to submit complaints to HHSC.