A Division of the Georgia Department of Community Health

(X)change Escalation Process

For a printable version of 2019 (X)change Escalation Process, click here. 
 
I. Assigned SHBP Unit
Eligibility and Benefits Administration (EBA), Employer Services Supervisor will monitor this process for compliance.
II. Responsibilities and Process
A. SHBP Employing Entities Responsibilities
1. SHBP Employing Entities (i.e., Employers) must request additional review for escalated inquiries.
2. Inquiries that meet the criteria below may be escalated for additional review via the (X)change.
 
(X)change Escalated Inquiry
1. Unsatisfactory resolution from employer services specialist.
2. Inaccurate resolution from employer services specialists.
3. Incomplete resolution from employer services specialists.
4. Closure of inquiry with no resolution (excludes resolutions closed due to the employer's failure to provide a response within time allotted. In these situations, the employer should resubmit a new inquiry and reference the prior inquiry number(s) assigned).
 
3. (X)change Escalated Inquiry Process
    i. Inquiry must be created in the (X)change
​a. Initial (X)change Inquiry: Employer must send an Employer (X)change Inquiry or have had the inquiry logged in the (X)change by an employer services specialist (note: Emails are not (X)change inquiries). Once the employer receives a resolution or the inquiry is automatically closed due to timing, if the employer believes the resolution requires additional review due to it meeting the “(X)change Escalated Inquiry” criteria above, the employer should follow First Level Reassignment instructions below. If no (X)change Inquiry has been submitted, the inquiry will not be considered escalated and will be referred back to the employer services specialists for a response.
 
b. First Level Reassignment: Employer shall request via the (X)change that the inquiry is escalated to the employer services supervisor. Once the employer initiates an “(X)change Escalated Inquiry” meeting the criteria above, the employer services specialists will reassign the inquiry or open a new inquiry to be reassigned to the employer services supervisor.

The employer services supervisor will review the inquiry and any supporting documentation submitted by the employer. The employer services supervisor may also request additional documentation from the employer if needed. If the employer does not submit the additional documentation requested, the employer services supervisor will close the (X)change Inquiry.

Once the employer receives a resolution from the employer services supervisor, if the employer believes the resolution requires additional review due to it meeting the “(X)change Escalated Inquiry” criteria above, the employer should follow Second Level Reassignment instructions below.
 
c. Second Level Reassignment: Employer shall request via the (X)change that the inquiry is escalated to the employer services manager. The employer services manager will review the inquiry and any supporting documentation submitted by the employer. Employer Services Manager may also request additional documentation from the employer if needed. If the employer does not submit the additional documentation requested, the employer services manager will close the (X)change Inquiry.

Once the employer receives a resolution from the employer services manager, if the employer believes the resolution requires additional review due to it meeting the “(X)change Escalated Inquiry” criteria above, the employer should follow Third Level Reassignment instructions below.

d. Third Level Reassignment: Employer shall request via the (X)change that the inquiry is escalated to the deputy executive director. The deputy executive director will review the inquiry and any supporting documentation submitted by the employer. The deputy executive director may also request additional documentation from the employer if needed. If the employer does not submit the additional documentation requested, the deputy executive director will close the (X)change Inquiry.

Once the employer receives a resolution from the deputy executive director, if the employer believes the resolution requires additional review due to it meeting the “(X)change Escalated Inquiry” criteria above, the employer should follow Fourth Level Reassignment instructions below.

e. Fourth Level Reassignment: Employer shall request via the (X)change that the inquiry is escalated to the executive director. The executive director will review the inquiry and any supporting documentation submitted by the employer. Executive Director may also request additional documentation from the employer if needed. If the employer does not submit the additional documentation requested, the executive director will close the (X)change Inquiry.

Once the employer receives a resolution from the executive director, the inquiry will be considered closed.