The state of Minnesota requires providers to report all quality complaints received at the clinic level to the enrollee's health plan. (Minnesota Statute 62D.123, Subd. 2 and Minnesota Rules 4685.1110 Subp.9) Complaints directed to the medical group are to be investigated and resolved by the medical group. Providers will also cooperate with Medica to resolve such complaints from members. Quality complaints are defined as concerns regarding access to services, communication/behavior, coordination of care, technical competence, and appropriateness of services affecting patient safety or comfort.
Medical groups must provide a written report to the Medica Quality Improvement Department on a quarterly basis. Please submit by the second Friday following the end of each quarter. Reporting is required even if no complaints are received during the quarter. Please see the Member Complaints section of your provider agreement, as well as the process and form at the links below.
Complaint Review Process
Quality Complaint Reporting form (PDF)
REV 9/2023