Filing a Grievance
A member grievance is defined as any member expression of dissatisfaction about any matter other than an "adverse action."
The grievance process allows the member or the member’s authorized representative acting on behalf of the member with the member’s written consent, to file a grievance in writing.
Filing a Grievance:
NH Healthy Families shall acknowledge receipt of each grievance in the manner in which is received. Any individuals who make a decision on grievances will not be involved in any previous level of review or decision making. In any case where the reason for the grievance involves clinical issues or relates to denial of expedited resolution of an appeal, NH Healthy Families shall ensure that the decision makers are healthcare professionals with the appropriate clinical expertise in treating the member’s condition or disease. [42 CFR § 438.406]
Timeframe for resolution of a Grievance:
Grievance resolution will occur as expeditiously as the member’s health condition requires, not to exceed 45 calendar days from the date of the initial receipt of the grievance.
Expedited grievance reviews will be available for members in situations deemed urgent, such as a denial of an expedited appeal request, and will be resolved within 72 hours.