Name of Manual - Blue Cross and Blue Shield of Minnesota

Quality Improvement
Complaint Review
System
Additional
requirements for
Select Network
Providers
Rationale:
The practice of managing patient complaints in behavioral health
clinics is consistent with practices in primary care clinics. Please
review the Complaint Review System section found under
Introduction to Quality Improvement for additional information on
maintaining a complaint review system.
Requirements:
Access and Availability Rationale:
All providers will have a policy and procedure in place detailing
the following:
• Process to receive written and verbal complaints for Blue
Cross members
• Designate an individual to be the primary contact for complaint
management, including the tracking of such complaints
• Document the substance of the complaint, the investigation,
and any actions taken
• Notify members of the right to complain and appeal to their
health plan
• Track complaints by categories and report at least annually to
an in-house committee
Members’ concept of the quality of care they receive often begins
when they make an appointment. Blue Cross wants to ensure that
members are able to schedule appointments in a timely manner;
commensurate with the level of care they need.
Requirements:
Routine initial appointments: 90% of requests within 10 business
days. Routine care is defined as a circumstance in which the
individual does not present either emergent or urgent conditions
and requests clinical services.
Follow-up appointment: 90% of requests within 10 business days
of the initial appointment.
3-20 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11)