1. Verify patient’s coverage in CHASSIS Software™
2. Determine if complaint can be resolved by providing the patient information or instructions (i.e. I cannot get an eligibility appointment,etc.)
3. If complaint cannot be resolved, take identified action based on type of complaint.
4. Include notes regarding call complaint in the contact.

CommUnityCare or other MAP/MAP BASIC contracted providers/services or staff (including unable to get a medical or dental appointment)

1. Transfer to MAP/MAP BASIC Complaint Hotline 512-978-8150
2. Inform patient they are being transferred to a recording and to please speak clearly and leave a name and phone number where they can be reached if they do not want to remain anonymous

MAP/MAP BASIC or eligibility policies, procedures, services (i.e. unable to get an eligibility appointment, do not like the facility or location, no parking, etc)

1. Explain policy or procedure to patient and attempt to resolve their issue
2. If unable to resolve the issue or patient wants to talk with a supervisor, transfer the call to the Eligibility Supervisor/Manager. Inform the client that if they get a voicemail to leave a detailed message and a phone number where they can be reached.
3. The Eligibility Supervisor/Manager will attempt to resolve the complaint
4. If the complaint remains unresolved, escalate to  Manager/Director.
5. Include notes regarding call complaint in the contact.

Central Health Eligibility staff/personnel

1. A client is calling to register a staff/personnel complaint:

• Utilize the Contacts Module Program Administration: Complaints-MAP Eligibility Complaints
• Inform client that the supervisor/manager will return their call within 3 working days
• If client would like to speak to the Call Center Supervisor or Eligibility Services Manager, transfer the call to the appropriate person and inform client that if they get a voicemail to leave their name, a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.
• Include notes regarding call complaint in the contact.

2.  If immediate assistance is needed:

• Transfer call to the Call Center Supervisor, if the Supervisor is not available, inform client that if they get a voicemail to leave their name, a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.

Fraud Complaints related to MAP/MAP BASIC eligibility

1. Transfer to Central Health Eligibility Services Manager
2. Inform client that if the call goes to voicemail to speak clearly, leave their name and a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.
3. Do not document information in client’s notes
4. Include notes regarding call complaint in the contact

Fraud Complaints non MAP eligibility related

1. Transfer caller to Central Health Alertline 512-978-8149
2. Inform client that if the call goes to voicemail to speak clearly, leave their name and a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.

Medical Management staff/personnel

1. Transfer to  Complaint Hotline 512-978-8150
2. Inform patient that if the call goes to voicemail to speak clearly, leave their name and a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.

An employee reporting directly to the Eligibility Services Director

1. Transfer to Eligibility Services Director
2. Inform patient that if the call goes to voicemail to speak clearly, leave their name and a detailed description of their complaint and a number where they can be reached if they do not want to remain anonymous.
3. Include notes regarding call complaint in the contact