Develop Corrective Action Plan for Complaint or Grievance

Submitted by admin on Tue, 05/04/2021 - 15:24
Policy: 

After recording a complaint, F/EA develops a corrective action plan and responds to the individual submitting the complaint within <<X>> business day(s). 

<<Staff Title>> reports complaints to the <<Staff Title>> immediately upon receipt. The <<Staff Title>> investigate the complaint and perform initial fact gathering. After fact gathering, <<Staff Title>> notifies <<Staff Title>> and <<Staff Title>> that a complaint was received.
 
Within one business day of receiving a complaint, <<Staff Title>>, <<Staff Title>>, <<Staff Title>> and any other applicable Customer Service, Billing or Payroll staff meet to review the situation and develop a corrective action plan.
 
Within one business day of receiving the complaint, <<Staff Title>> (or <<Staff Title>> or <<Staff Title>>, when appropriate) contact the participant or representative who placed the complaint and report F/EA’s corrective action plan for his/her complaint. The corrective action plan is submitted to the participant in writing on the same day that verbal communication of the corrective action plan is performed. Corrective action plans are submitted in writing for all complaints, regardless of if complaint was received via phone, mail or in person.
 
If implementation of the corrective action plan is not sufficient to resolve the participant’s complaint, F/EA arranges for a hearing with the participant, including the presence of a neutral party in accordance with the American Board of Arbitration guidelines.
 
All communication is recorded. All written documentation is scanned to the participant’s scan folder and maintained for a minimum of 7 years per File Retention Policy.
Procedure: 

 

  1. After recording a complaint or grievance <<Staff Title>> notifies <<Staff Title>> verbally or via e-mail that a complaint has been received
  2. <<Staff Title>> works with <<Staff Title>> to find as many facts about the situation as possible
  3. Facts sought vary by issue, but facts often sought are:
  • Check date of payment in question
  • Check number of payment in question
  • Worker/vendor associated with payment in question
  • Timesheet(s)/invoice(s) associated with payment in question
  • Date timesheet(s)/invoice(s) faxed or mailed
  • Individual budget details associated with payment in question

 4.  After fact-seeking, and on the same day that the complaint is received, <<Staff Title>> notifies <<Staff Title>> and <<Staff Title>>, verbally or in writing, that a complaint has been received

 5.  <<Staff Title>> schedules meeting with <<Staff Title>>, <<Staff Title>> and applicable Customer Service, Payroll or Billing staff to occur on or within one day of receiving complaint

 6.  During meeting, all parties review facts as presented by <<Staff Title>> and seek additional facts as necessary

 7.  After collecting relevant facts, meeting attendees develop a corrective action plan to resolve the participant or representative’s complaint or grievance while maintaining compliance with program rules and regulations

 8.  <<Staff Title>> drafts a letter that outlines the corrective action plan

 9.  Corrective action plan must include expected dates of completion for each element in plan

10.  <<Staff Title>> calls participant or representative

11. <<Staff Title>> shares with participant or representative F/EA’s corrective action plan to resolve the complaint or grievance

12. <<Staff Title>> records communication in Payroll System per Policy and Procedure document

13. <<Staff Title>> submits written corrective action plan to participant or representative

14. <<Staff Title>> records in Customer Service System per Policy and Procedure that written corrective action plan was submitted to participant

15. Written corrective action plan and fact-seeking document are scanned to participant’s scan folder and maintained for a minimum of 7 years per File Retention Policy

16. If the participant or representative is not satisfied with the corrective action plan, he/she will contact F/EA within 3 business days of receiving the plan in writing

17. <<Staff Title>> will schedule a hearing with a mediator in an effort to resolve the issue to both partys' satisfaction

Internal Controls: 

The internal controls used by F/EA to monitor this process establish responsibility, segregate duties, document procedures and ensure independent internal verification.

  1. All complaints and grievances are coded and recorded in Payroll System
  2. All complaints and grievances are reported to the <<Staff Title>> for review immediately upon receipt
  3. All complaints and grievances are reported to the <<Staff Title>> and <<Staff Title>> on the same business day as they are received
  4. All facts pertaining to complaint or grievance are sought and documented within 1 business day of receipt of complaint
  5. A corrective action plan is submitted to the participant in writing
  6. The corrective action plan and fact seeking document are scanned to the participant’s scan folder and maintained for a minimum of 7 years per File Retention Policy