What is an eligibility grievance?

An eligibility grievance is an expression of dissatisfaction about any matter other than an eligibility decision.

Examples of an eligibility grievance might be:

• Poor behavior by an employee of the KanCare Clearinghouse during the eligibility or renewal process.
• Failure to respect an applicant/member’s rights and dignity during the eligibility or renewal process.
• Concerns about your access to care due to the eligibility and renewal process.
• You are unhappy with the customer service during the eligibility and renewal processes.

How do I submit an eligibility grievance?

The applicant or member or their authorized representative may submit an eligibility grievance by telephone or in writing.

To submit an eligibility grievance by telephone call:

• Call Center Phone Number: 1-800-792-4884
• TDD/TTY Phone Number: 1-800-792-4292

To submit an eligibility grievance by fax send to:

• Family Medical Fax Number: 1-800-498-1255
• Elderly & Disabled Fax Number: 1-844-264-6285

To submit an eligibility grievance by mail send to:

KanCare Clearinghouse
P.O. Box 3599
Topeka, KS 66601-9738

To submit an eligibility grievance in person go to:

KanCare Clearinghouse
650 SE Airport West Drive
Topeka, KS 66619

Is there an Eligibility Grievance Form?

No specific grievance form is required when submitting an eligibility grievance.

Is there a deadline for filing an eligibility grievance?

No, an applicant, member or their authorized representative may submit an eligibility grievance at any time.

What is the process once an eligibility grievance has been submitted?

The Medicaid agency will call or send a letter of grievance resolution to the applicant, member or their authorized representative within 30 calendar days following the date of resolution of the grievance.

What is a managed care grievance?

A managed care grievance is an expression of dissatisfaction about any matter other than an adverse decision or an action.

Possible subjects or examples of a KanCare Grievance might be:

• You are unhappy with the quality of your care or services provided.
• Poor behavioral by an employee of the MCO or their provider.
• The failure to respect a member’s rights and dignity.
• You received a bill from a provider that should be covered by KanCare (your MCO) and the MCO said they are not covering it.

How do I submit a managed care grievance?

The beneficiary or member or their authorized representative may submit a managed care grievance by telephone or in writing. The contractor cannot require a written form from the member or member’s representative for a grievance.

To submit a managed care grievance by telephone call:

• Aetna 1-855-221-5656 or TTY 711
• Sunflower 1-877-644-4623 or TTY 711
• United 1-877-542-9238 or TTY 711

To submit a managed care grievance by fax sent to:

• Aetna 1-833-857-7050
• Sunflower 1-888-453-4755
• United Healthcare Not Available

To submit a managed care grievance by mail sent to:

Aetna
Appeal and Grievance Department
9401 Indian Greek Parkway, Suite 1300
Overland Park, KS 66210

Sunflower
Quality Department
8325 Lenexa Drive, Suite 200
Lenexa, KS 66214

United
Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

To submit a managed care grievance in person go to:

Aetna
Appeal and Grievance Department
9401 Indian Greek Parkway, Suite 1300
Overland Park, KS 66210

Sunflower
Quality Department
8325 Lenexa Drive, Suite 200
Lenexa, KS 66214

United
10895 Grandview Drive
Suite 200
Overland Park, KS 66210

Is there a form I can use?

No specific grievance form is required when submitting a member managed care grievance.

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No, a beneficiary, member or their authorized representative may submit a managed care member grievance at any time.

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The MCO will send the grievance acknowledgement letter to the beneficiary, member or their authorized representative within 10 calendar days from the date of receipt. For grievances resolved the same day of receipt, the MCO is not required to issue an acknowledgement, but will acknowledge receipt of the grievance in the notice of member grievance resolution.

The MCO will resolve the grievance and mail you or your representative the grievance resolution letter within 30 calendar days following the receipt of the grievance.

What is a FFS grievance?

A grievance is defined as an expression of dissatisfaction about any Fee For Services matter including an adverse decision.

How do I submit a FFS grievance?

The member or member’s authorized representative may submit a grievance either orally or in writing. The contractor cannot require a written form from the member or member’s representative for a grievance.

To submit a FFS grievance by telephone call:

• 1-800-766-9012 – Members
• 1-800-933-6593 - Providers

To submit a FFS grievance by fax send to:

• 785-267-7687

To submit a FFS grievance by mail send to:

DXC Technology
Grievance and Appeals Team
P.O. Box 3571
Topeka, KS 66601-3571

Is there a FFS Grievance form?

No specific grievance form is required when submitting a FFS grievance.

Is there a deadline for filing a FFS member grievance?

No, a beneficiary, member or member’s authorized representative may submit a member grievance at any time.

What is the process once a FFS grievance has been submitted?

The FFS grievance will be resolved within 30 calendar days of receipt of the grievance from the FFS beneficiary.

The resolution of the grievance will be communicated to the FFS beneficiary by telephone or letter.