CIMRO of Nebraska will use Alternative Dispute Resolution (ADR) techniques in appropriate beneficiary complaint cases for which there is no significant concerns about the quality of care provided.  ADR options include mediation, facilitated resolution and external resolution.

Mediation is a form of conflict resolution in which an external, impartial third party—a mediator—brings the parties together to discuss with each other the issues and concerns identified in a complaint related to Medicare services.  Mediation is a cooperative, voluntary, and confidential process, conducted in a safe environment.  Its goal is to reach a resolution based on the interests of both parties.

Facilitated Resolution occurs when CIMRO of Nebraska designates a facilitator, an intermediary who will speak to each party in separate, independent telephone discussions. The facilitator conveys information from the beneficiary to the provider describing the identified concerns and what the beneficiary says could have happened to prevent the complaint.

External Resolution or “self resolution” occurs when, in the course of pursuing one or both of the ADR options, a provider initiates a contact to the beneficiary or the beneficiary contacts the provider to discuss what might be done to resolve the complaint.  External resolution addresses the issues outside of CIMRO of Nebraska’s involvement and it may or may not be within an organization’s established complaint or patient review process.

For additional resources, please view the Documents and Links sections.