HHSC defines a complaint as any dissatisfaction expressed by telephone or in writing by the pharmacy provider. The definition of complaint does not include a misunderstanding or a problem of misinformation resolved promptly by clearing up the misunderstanding or supplying the appropriate information to the provider's satisfaction.
Pharmacy providers submit pharmacy complaints to the appropriate MCO. Refer to the MCO's website to obtain information regarding complaints and appeals processes and the MCO's procedure manual.
Each MCO must resolve pharmacy provider complaints within 30 days from the date the MCO receives the complaint. The MCOs are also required to resolve pharmacy provider complaints received by HHSC and referred to the MCOs no later than the due date requested by HHSC.
Pharmacy providers must exhaust the complaints or grievance process with the MCO before filing a complaint with HHSC. If a pharmacy provider believes it did not receive the entire due process from the MCO after completing this process, you may file a complaint with HHSC. Pharmacy providers should contact the client's specific MCO for details.