February 28, 2022
Quality of Care (QoC)
Blue Cross and Blue Shield of Texas (BCBSTX) Quality Improvement investigates concerns and potential quality of care (QoC) complaints or deficiencies in clinical care, as reported by providers, service coordinators, case management and members or a member’s authorized representative involving Providers that are in the network.
What is a Quality of Care Concern?
A Quality of Care concern is a dissatisfaction with the quality of clinical care rendered in individual occurrences. Medical QoC concerns may include, but are not limited to:
- A condition that was not appropriately diagnosed
- A condition that was not appropriately treated
- A member had to obtain care elsewhere because of dissatisfaction or concern about care received from a contracted provider/facility
- Medication/treatment errors
- Delayed referrals
- Incidents affecting patient safety
Report Abuse to the Texas Department of Family and Protective Services (DFPS):
- Website: https://www.dfps.state.tx.us/contact_us/report_abuse.asp
- By phone for urgent matters: 1-800-252-5400
- Online for non-urgent situations: https://www.txabusehotline.org/Login/Default.aspx
To file a Quality of Care Complaint with BCBSTX, please submit to BCBSTX Appeals and Grievance Team via:
- Fax #: 1-855-235-1055
- Email: TX_Medicaid_A&G_complaints@bcbstx.com
References
Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and THSteps for Medical Providers which includes all current vaccine schedules, ImmTrac2, and other important guidance for treating your patients.
Have questions?
Contact Angie Mashchenski RN, Quality Management Specialist III at angie_mashchenski@bcbstx.com.