Provider Reporting Requirements
CCCW providers will communicate appropriately with member/guardian and MCO Support Coordinators.
- Providers shall report change in member's condition, injury, hospitalization, or critical incident within 24 hours to guardian and Support Coordinators.
- Providers shall notify MCO of formal complaints or grievances received from MCO members within 48 hours of receipt. Written notification of completed complaint investigations will be forwarded to MCO.
- Member's Support Coordination team will receive timely, accurate, and comprehensive information relating to the services provided.
- Respond to, document and notify MCO within 1 business day when the member is involved in a adverse event. This includes any substantiated event, incident, or course of action, or inaction resulting in:
Falls, with or without injury, occuring at any location, including facility.
Medication Errors, including a missed medication, wrong dose or time, or a refusal to take a scheduled medication.
Missing Person, even if located without injury or without needing to ask Police for help.
Any new diagnosis or exacerbation, (worsening or reoccurrence) of a known disease or illness.
Any health related incident requiring law enforcement, fire department, or other emergency response systems.
Hospitalization or ER/Urgent Care or unscheduled doctor visits.
Substantial harm to the health, safety, and well being of the member, including death, serious illness or accident requiring immediate care of treatement by a health care professional.
Change in condition lasting more than one day. This may include, but is not limited to a change in mental status (i.e. confusion or aggression), change in sleep pattern, increase/decrease in appetite, change in functional status (i.e. inability to dress self, difficulty walking, eating), etc.
Self harm or harm to others
Property damage. Substantial loss in the value of the personal or real property of the member due to theft, damage, or exploitation.
Violation of the member's rights.
Any incident requiriing an abuse/neglect/exploitation investigation.