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Grievance Information
About Grievances
ESRD Network 10 is contracted by the Centers for Medicare/Medicaid Services (CMS) as an End-Stage Renal Disease (ESRD) Network and authorized under the Social Security Act to receive, investigate, and process grievances related to the quality and safety of care received by patients in Medicare-certified dialysis or transplant facilities in the state of Illinois. Grievances are reviewed in accordance with the Conditions for Coverage (CfC).
Patient Rights & Responsibilities
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Patient Rights & Responsibilities Spanish
Download 103.28 KB 58 downloadsHow to File a Grievance
You can contact Network 10 by phone or mail
Toll Free at (800) 456-6919
Qsource ESRD Network 10
911 E. 86th Street, Suite 202
Indianapolis, IN 46240
Network 10 has an experienced staff available Monday through Friday to address your concerns.
Patients wishing to be represented by a family member or other individual, must submit a CMS Appointment of Representative Form.
In filing a grievance, a patient may remain anonymous to the facility. Network 10 will not release a patient’s name to the facility without the patient’s permission. However, anonymous grievances allow the Network to do only a general investigation. Patients will be asked to indicate their preference to disclose or not to disclose their name by completing a Consent to Disclose Your Identity form.
See this helpful resource from the ESRD NCC on How to File a Grievance.
Patient Developed Tool
See this helpful tool on the Forum of ESRD Networks website for more information on filing a grievance.
Grievance Resources
Grievance Root Cause Analysis
Staff Retaliation Resources
Staff Retaliation Poster
Download 2.20 MB 213 downloadsWhat is the Network Role?
Network 10’s Patient Services Department handles questions related to the quality and safety of care received by patients and any questions regarding grievances process. Our role in resolving grievances, depending upon the situation, is to act as:
- Investigator
- Facilitator
- Advocate
- Educator
- Coordinator
- Referral Agent
Contact Patient Services
- Call: 317-257-8265 or 800-456-6919 (toll-free patient line).
- Mail questions to:
Qsource ESRD Network 10
911 E. 86th Street, Suite 202
Indianapolis, IN 46240
Attention: Patient Services Department.
When the Network is contacted regarding a concern, it will attempt to resolve the issue in one of the following ways:
- Assist patients who wish to address the issue on his/her own by helping to organize his/her thoughts about a situation and by providing information regarding their rights and responsibilities;
- With permission from the patient, the Network may contact the facility directly to gather information and attempt to resolve the matter;
- The facility may be required to complete an Improvement Plan to correct problems;
- More serious issues may be referred to the Network’s Medical Review Board (MRB) for review;
- Life-threatening situations will be referred to the appropriate State Survey Agency for immediate action.
- If the grievance involves a concern that falls under another agency’s or organization’s authority, the Network will refer the grievance in accordance with CMS established Guidelines.