The providers grievance policy defines the process to be used by HealthPlus of Michigan for resolving administrative complaints by, and disputes with, participating providers under their provider agreements.

When a provider has a concern, every effort will be made to resolve the issue informally. In the event the issue cannot be resolved informally, the provider may request it be handled according to the formal grievance policy. The Provider Service Department will be the liaison between the providers and the health plan and will provide the information regarding the formal process.

If a provider feels aggrieved by a policy, decision, or procedure of HPM, he/she shall follow the grievance procedure set forth below:

Informal Procedure
An aggrieved party must first send a written statement outlining the nature and extent of the problem. The parties will meet within 45 days to discuss the problem with the appropriate provider and HPM administrator. It is recognized
that many problems may be solved this way and a formal grievance may thereby be avoided.

Formal Hearing
If the meeting does not resolve the situation, then the responding party shall, within five days, send a written response to the original written grievance.

Upon receipt of the notice, a tribunal shall be formed composed of one representative appointed by HPM, one representative appointed by clinic, and a third representative, who shall be chairperson, who shall be selected by the two appointees (hereinafter referred to as the "Tribunal"). This Tribunal shall conduct a hearing upon the merits of the dispute within 30 working days of receipt of the notice, unless the parties agree to a longer time. Within five working days from the termination of the hearing, the Tribunal shall issue a decision in writing to all parties involved in the dispute. All procedures surrounding said Tribunal function shall be determined by said Tribunal, unless inconsistent with this paragraph. Each party shall bear the cost of the representative it appointed plus one-half of the expenses of the neutral representatives and other associated costs.

Appeal Process
If any party declines to accept that decision, that party has seven days in which to file a formal written appeal of that decision to both boards of HPM and clinic.

Upon receipt of the notice of appeal, a grievance committee shall be convened within 30 days to decide this appeal. The grievance committee shall be a committee of HPM or a nationally recognized arbitration panel, as mutually agreed upon. The
committee shall provide the aggrieved party with an opportunity to be heard prior to making its final decision. All other procedures concerning the grievance committee shall be binding upon all of the parties to the appeal and all third party
beneficiaries (other than member) and no further appeal shall be permitted.  The cost of the grievance committee shall be equally borne by the parties to the arbitration.