HMO - Medica Health Plans

HMO Complaint Category Reporting

MDH goals were to have complaint category reporting by HMOs to be;

  • As least burdensome as possible yet meet the statutory requirements;
  • Consistent with Statutory language;
  • Comparable to grievance reporting done to DHS for MHCP;
  • Easily mapped to NCQA categories.

To that end, the following are the required complaint category reporting;

  • Complaint categories with definitions;
  • Complaint outcomes;
  • Quality of Care Severity levels;
  • HMO Complaint Reporting Requirements.

HMO Complaint Category Reporting (PDF)

A template for HMOs to use for reporting the Complaint Category data to MDH will be posted at a later date.

For more information, email Tricia VanEschen.

Updated Thursday, September 28, 2017 at 09:00AM November 2013