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Grievance and Appeals

Grievance and Appeals

Location and Contact Information

Mon-Fri, 8 AM – 5 PM
1430 Collier St.
Austin, Texas 78704
P: 512-440-4086
F: 512-445-7745
Ombudsman@atcic.org

Integral Care values their providers. Should you feel a need to voice concerns, questions or other commentary, contact Integral Care’s ombudsman at ombudsman@atcic.org or call 512-440-4086. The ombudsman is responsible for receiving and resolving complaints. For more information you may also refer to the full Provider Manual posted under resources.


How it Works

All Provider Complaints not resolved at the division level are routed to Integral Care's Ombudsman.

  • Providers with any Complaints or suggestions are encouraged to call or e-mail the Ombudsman.  Every effort will be made to resolve all Complaints informally within a short period of time.
  • If a written complaint is not resolved to the Provider’s satisfaction within 30 days after the Ombudsman receives it, the Provider may submit a written request for an appeal of the unsatisfactory resolution to the Ombudsman.

  • A provider has 15 calendar days from a denial to request an appeal. The first level appeal is completed by the Network and Management Authority Officer. If the denial is upheld the provider may initiate the second-level appeal--an appeal committee.

  • The determination by the Appeal Committee is final.

  • Appeals related to Utilization Management/Resource Allocation is a separate process through Utilization Management.


What to Expect

Once a complaint is received, the Ombudsman will clarify the issue with the complainant. The Ombudsman makes every effort to answer complaints and respond timely. Division staff will be contacted for assistance as appropriate. The Ombudsman will keep providers' informed of the process and give further details as needed.

Joint Comission