Working Through the Complaint Process with Medicaid Managed Care


[3367] Working Through the Complaint Process with Medicaid Managed Care
Extremely helpful... TX HHSC explains the process for the complaint process and how to handle with the MCOs...

NOW AVAILABLE: RELEASED 03/02/2020 This program was presented on 2.12.2020 at the Texas Association of Home Care & Winter Conference in Denton. It is one of 18 presentations captured and produced for online access.

Presentation Info:

  • Presentation Date: February 12, 2020
  • TAHC&H Event: TAHC&H Winter Conference | Denton

Subscription Type: Individual

Education-Training Credits:

  • TX HCSSA Administrator/Alternate Continuing Education
    • 1.0 Clock Hrs

CE Approval Statements:
· This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.

HCSSA Topic(s) Addressed:

  • §558.259[d][4]agency responsibilities
  • §558.260[a][3]basic principles of management in a licensed health-related setting

Program Description: TX HHSC staff provide a robust discussion of the complaint process related to Texas Medicaid Managed Care Organizations. Every wonder what happens when you lodge a complaint with HHS? What if an MCO states they did not receive your complaint, then what? What are agency’s rights and the MCO’s timelines for follow up on a complaint? This session addresses these questions and many more common issues experienced by providers when lodging complaints both with MCOs and HHSC. Agencies will find this session extremely helpful with HHSC explaining the process for the complaint process and how to handle with the MCOs. HHSC provides guidance on the steps and timeframes to assist agencies with completing a complaint and also advises on agency rights when filing complaints.

Program Learning Outcome: Participants will be able to identify the process and steps on how to lodge a complaint with HHS and describe how to complete the process timely.

TAHC&H Faculty/Presenter: Camisha D. Banks, CTCM, Director of Provider and Client Services, Managed Care Compliance and Operations, Medicaid and CHIP Services; Michael Osborne, Senior Manager, Medicaid and CHIP Services

About the Presenters:
Camisha D. Banks
is currently serving as Managed Care Compliance & Operation’s (MCCO) Interim Assistant Director. Camisha is currently the MCCO Director of Provider and Client Services over the managed care complaints, trending and reporting, as well as call centers for transportation and pharmacy. She has worked in several capacities of the Medicaid program for more than 25 years, and began her state career in 2007 as a Health Plan Specialist in MCCO (formerly Health Plan Management). Since that time, Camisha has served in increasing responsible positions as a health plan manager and as a senior manager overseeing several of the complex Managed Care Organizations (MCOs).

Michael Osborne has 25 years of State Service with The Texas Department of Health and the Health and Human Services Commission. He has 17 years with the Vendor Drug Program, assisting with pharmacy providers with Point of Sale claims and software issues. Michael also has 8 years with Managed Care Compliance and Operations, Senior manager of Research and Resolution. He coordinates complaints, from various stakeholders, against the MCOs to ensure the timely delivery of contracted services and benefits to members and reimbursement to the providers.

[3367] Working Through the Complaint Process with Medicaid Managed Care

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