Provider Unresolved Complaint Form
Working with managed care organizations (MCOs) can be frustrating, especially when they don't follow the rules. The Academy is here to help you. In order to help you, we need to know when there is a problem. And not just any problem.
One that the MCO just doesn't want to resolve, keeps happening over and over and over again, or you don't feel comfortable confronting the MCO about it.
Please fill out the form so that we can track unresolved complaints. And if you would like The Academy to do so, we will work with you to help find a solution.
First, we need to collect a little information about you. Don't worry, we won't share this information with anyone without asking you first.
Type of provider
Select type of provider
Skilled Nursing Facility/Nursing Home
Residential Care Facility/Assisted Living
Home Health Care
Adult Day Care
Durable Medical Equipment (DME) Supplier
Parent Company (if applicable)
Facility or Company Name
We need to learn a little about the issue you are having. We will do that on the following page.
Do Not Fill This Out