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Complaint Procedures

Superior recognizes that there are times when a provider may not be satisfied with a matter handled by Superior. Providers have the right to file a complaint related to that matter. The Complaint Procedures page will describe the process to file a complaint, the response timeframes and the complainant’s rights during the process. The complaint process does not include appeals for determinations/actions based on medical necessity. Appeals for determinations based on medical necessity are outlined in the Provider Manual.

A complaint is an expression of dissatisfaction communicated by a complainant, orally or in writing, about any matter related to Superior, other than an action/adverse determination. As provided by 42 C.F.R. §438.400, possible subjects for complaints include, but are not limited to:

  1. The quality of care of services provided;
  2. Aspects of interpersonal relationships such as rudeness of a provider or employee, or
  3. The failure to respect the Medicaid member’s rights.