Member Rights and Responsibilities
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Texas Health and Human Services Commission (HHSC)
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Texas Medicaid and Healthcare Partnership (TMHP)
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It is critical that RightCare providers develop a culturally competent system of care — one that acknowledges and incorporates at all levels the importance of culture and the adaptation of services to meet culturally-unique needs.
RightCare members vary in language and culture (e.g., customs, religion, backgrounds, etc.). Our goal is to effectively serve members of all cultures, races, ethnic backgrounds, and religions in a manner that recognizes values, affirms, and respects the worth of the individuals and protects and preserves the dignity of each. We must operate at a level in which cultural knowledge is high and policies and practices are in place that produces positive results and satisfaction from the viewpoint of the culturally diverse client.
Filing Complaints to RightCare
If a provider is dissatisfied with RightCare’s policies, procedures, coverage or benefit decisions or with any aspect of the member’s treatment by physicians, hospitals or other providers, he or she have the legal right to file a complaint to RightCare and/or the Health and Human Services Commission (HHSC).
Provider can file a verbal complaint by calling Customer service at 1-855-897-4448/ TTY 771. RightCare recommends that all complaints received from providers be submitted in writing to:
- RightCare from Scott & White Health Plan
- Attn: Dispute Resolution MS-A4-144
- 1206 West Campus Drive Temple, TX 76502
- Or by email to: firstname.lastname@example.org
- or fax to 254-298-3086.
Note: Any complaints received at the wrong address will be returned to the sender.
Provider Complaint Process to HHSC
A provider who believes that they did not receive full due process from RightCare may file a complaint with HHSC. Providers must exhaust the complaint process with RightCare before filing a complaint with HHSC. Complaints can be submitted orally or in writing and received by HHSC at the following address:
Provider Claim Appeal
A claim appeal is a request for reconsideration of payment for a previously adjudicated claim. Providers who are filing an appeal of a claim decision will need to submit a copy of the Explanation of Benefits (EOB) page showing the claim in question, a claim form, and other supporting documentation including the reason for the appeal. Providers should submit one copy of the EOB for each claim to be appealed and circle which claim is being appealed. The reason for the appeal or reconsideration request may be written on the EOB or described in a separate document. All information should be printed on a single side of the copy. If the original claim was denied for incorrect information, a new CMS 1500 or UB-04 with the corrected information should be submitted as a corrected claim. Appeals must be written and submitted within 120 days from the date of disposition, which is the date on the Remittance Advice. RightCare will adjudicate all appeals within 30 days of receipt of the appeal.
Submit all correspondence to:
- Scott and White Health Plan
- PO BOX 981727
- El Paso, TX 79998-1727
- Electronic submission through provider portal: rightcare.firstcare.com/Web/
Note: Any complaints or appeals received at the wrong address will be returned to the sender.
Prior Authorizations (PA)