• Consumer complaints are recorded and reviewed regularly by BJCBH & BHP
   
• Consumer complaint calls may be taken by a BJCBH & BHP case manager, quality improvement manager or utilization managemer for immediate resolution; written complaints should be referred to the quality improvement coordinator or utilization manager for follow-up
   
• If the complaint is successfully resolved at this level, no formal process is implemented
   
• If complaint issues cannot be resolved at this level, the BJCBH & BHP quality improvement manager or utilization manager completes the member complaint form, and acknowledges concerns by telephone or in writing within two business days
   
• The BJCBH & BHP QM Department keeps a documented record of all steps taken to resolve the dissatisfaction
   
• BJCBH & BHP QM Department attempts to resolve complaints or grievances within 10 days of receipt of all information necessary to provide an impartial review of the issue
   
• The member filing the complaint is advised in writing of the final resolution of the issue(s) within 30 days by the quality improvement coordinator with written instructions on how to request additional review

A consumer also may file a complaint or grievance with the quality manager of BJCBH & BHP, and an impartial review will be conducted. A client or member may mail a copy of the complaint, grievance or appeal to the health-care plan or -- if funded by DMH -- the client rights coordinator for the Missouri Department of Mental Health.

Quality Manager for BJCBH & BHP
1430 Olive Street, Suite 400
St. Louis, Missouri 63103 USA
phone -- 314.206.3776
toll-free -- 800.866.6030

Consumer Rights Coordinator
Department of Mental Health
P. O. Box 687
Jefferson City, Missouri 65102-0681 USA
phone -- 800.364.9687

Division Director
Comprehensive Psychiatric Services
P. O. Box 687
Jefferson City, Missouri 65102-0681 USA
phone -- 800.364.9687

Provider Complaints

• Provider complaints are recorded and reviewed regularly by BJCBH & BHP
   
• Provider complaints should be directed to:
  Network Management Specialist
  c/o BJCBH & BHP
  1430 Olive Street, Suite 400
  St. Louis, Missouri 63103 USA
  phone -- 314.206.3809
  phone -- 314.206.3751
   
• If the complaint is successfully resolved at this level, no formal process is implemented
   
• If complaint issues cannot be resolved at this level, the BJCBH & BHP quality improvement coordinator, the utilization manager or utilization management coordinator completes the provider complaint form, and acknowledges concerns by telephone or in writing within two business days
   
• A record of all provider complaints regarding services and documentation of all steps taken to resolve the dissatisfaction is maintained by the BJCBH & BHP UM/QM Department
   
• The provider filing the complaint is advised in writing of the final resolution of the issue(s) within 30 days by BJCBH & BHP

Providers' Fair Hearing and Appeals Process
BJCBH & BHP has a process to review and resolve disputes that may result from credentialing and privileging decisions.

If a practitioner's application is denied by BJCBH & BHP, based on the practitioner's professional competence or conduct, a practitioner may request a hearing to review the decision. A letter detailing the fair hearing and appeals process is mailed to the practitioner detailing the process