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Submit a complaint

ACHC Complaints Policy

ACHC will document and investigate all complaints. ACHC regards all complaints as confidential and it is our policy to protect your name. However, it may become necessary to reveal your identity in order to validate your complaint.

Does your complaint concern ACHC or an accredited organization? *ACHCOrganization

Complaints against ACHC

ACHC strives to deliver services as promised and to provide the best possible experience to every customer. If at any time we fail to meet your expectations, please submit the form below or reach out to us at complaints@achc.org.

First Name *

Last Name *

Email Address *

PhoneProviding your phone number is optional, but it could help us quickly resolve your questions.

Company you are affiliated with

City

State / Region

Complaint *

Complaints against ACHC-accredited organizations

First, attempt to resolve any issues with the provider in question. If that is unsuccessful, please contact ACHC. We will
investigate to determine whether the organization in question is in breach of either ACHC Accreditation Standards or applicable or applicable Medicare regulations (CoPs, CfCs, and/or Quality Standards). If the complaint involves possible abuse, neglect or exploitation, unprofessional conduct, or noncompliance with state or federal laws, ACHC will notify the appropriate regulatory authority.

If violations cannot be confirmed, ACHC has no authority to take further action. ACHC does not have jurisdiction in labor
relations issues, payments, billing, or contracts with third-party payors (Blue Cross Blue Shield, Aetna, Humana, etc.).

Have you contacted the accredited organization directly regarding your complaint? *YesNo

We recommend you contact the organization and address your issues with the organization first so they have an opportunity to follow their own complaint process. Please note that you may find contact details for their complaint process on your customer care/welcome/patient intake packet or original documentation.

Please complete our electronic Complaint Intake Form so that we may obtain all relevant details about the nature of your complaint. If you need further assistance, email complaints@achc.org.

Program *

Admission/Start of Care date *

Services received/provided *

Are you a Medicare beneficiary? *YesNo

Equipment Delivered *

Problems Began *

Final Date Care was Received *

Services Received/Provided *

Complainant Information

Complainant Name *

Complainant Email *

Patient / Client / Resident Name *

Complainant Relation To You *

Street Address *

City *

State *

Zip *

Main PhoneProviding your phone number is optional, but it could help us quickly resolve your questions.

Mobile PhoneProviding your phone number is optional, but it could help us quickly resolve your questions.

Accredited Organization Information

Accredited Organization / Residence *

Street Address *

City *

State *

ZIP *

Contact Name *

Main PhoneProviding your phone number is optional, but it could help us quickly resolve your questions.

Complaint Details and Summary

Complaint Summary

Provide a brief and factual summary of your issue(s) with any information you feel may assist in our investigation. Please include as many details as possible, including dates and times of events that relate to your complaint, as well as names of persons who have information about the complaint and the names of any persons with whom you have discussed the events relating to the complaint, and your best recollection of the dates and times of any of these discussions.

Complaint Summary *0 / 5000

Previous Contact

Date organization was contacted with complaint

What was the response from the organization to your complaint?

Have you contacted the State Agency or CMS with your complaint? *YesNo

Agency Contacted *0 / 5000

Date Contacted *

Other action you have initiatedEx: Better Business Bureau, State/Federal Agencies

Witnesses Name:

Witness Name

Relevance to complaint

Consent to ACHC Investigation

ACHC's Accreditation Standards define procedures for the delivery of health care services. Our Accreditation Standards incorporate standards from state and federal laws and the health care industry. After receiving your complaint, ACHC will conduct an initial review and assessment to determine if your complaint involves a potential violation of the ACHC Accreditation Standards. After this initial review and assessment, ACHC will inform you whether we have decided to start an investigation, and we also will inform you of the result of our consideration of your complaint.

Other than disclosures to government agencies, ACHC will not disclose the names of complainants, patients, or witnesses unless permission is given in the form below. However, the provider organization’s detailed investigation and corrective actions regarding your complaint may provide clues as to these identities. Therefore, while we honor all requests not to divulge particular names, ACHC cannot guarantee anyone's anonymity.

When you click “Submit Complaint” below, you are attesting that all the information provided in this electronic form is true to the best of your knowledge, and that ACHC has your express permission to disclose your identity as the complainant. ACHC also has your permission to disclose the identity of each patient and witness that you have approved in the “Name Release” section below.

Name Release

Complainant Name *YesNo

Patient/Client/Resident Name *YesNo

Witness Name *YesNoN/A

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Please do not fill in this field.

Accreditation Commission for Health Care, Inc.

139 Weston Oaks Ct. | Cary, NC 27513

customerservice@achc.org

Toll-free: (855) 937-2242 | Fax: (919) 785-3011

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