Our Commitment to Quality
At PerformCare, we are committed to ensuring that children, youth, and young adults receive the care they need, and we are always looking for new ways to improve our services. Our Quality Improvement (QI) program systematically monitors and evaluates the quality of clinical care and service delivery by PerformCare staff, as well as our service providers.
We use proven approaches to check how we are doing and determine how we can improve. Through the QI program, we:
- Watch for things that show a need for improvement.
- Perform service delivery studies when we see they are needed.
- Monitor the quality of care and services given by providers.
- Use family feedback to improve our services.
Concerns: Reconsiderations, complaints, and appeals
In general, if you have a concern about the services you have requested or are accessing through PerformCare, there are three options for a family: complaints, Reconsiderations, and appeals.
Complaint: A concern regarding the quality of services, filed with PerformCare via a phone call or in writing. You may have a complaint if you are dissatisfied by a component of the care you have received, such as the quality of a service, timeliness, or provider performance.
PerformCare is responsible for resolving complaints for the New Jersey Children's System of Care (CSOC). When you have a concern about the quality of services in the system, you have the right to file a complaint. Your child’s care will not be impacted by your complaint.
Your first step is to address the complaint with the person or agency with which you have the concern. If you are not satisfied with the result after going through their review process, you may submit a complaint to PerformCare.
Reconsideration: A request to PerformCare to change a decision regarding an authorized service, through a phone call or in writing.
If you have a concern about a decision made by PerformCare or a service provider authorized by PerformCare, such as a change in the type or amount of services or a denial or termination of services, you may be eligible to request further review of the situation. PerformCare staff is available to assist you in this process. The type of dispute resolution to which a youth or family is entitled varies depending on the services for which the youth or family is eligible.
You can submit a complaint or a Reconsideration request by calling PerformCare at 1-877-652-7624 or writing to:
300 Horizon Center Drive, Suite 306
Robbinsville, NJ 08691
Appeal: Formal appeals are available to families and youth when a request for service(s) has been denied, terminated, or reduced. Families can also file for an appeal if there is a disagreement with the type of service authorized. A formal filing is required in writing, and is made directly to the New Jersey Children's System of Care.
If you are not satisfied with the outcome of a Reconsideration, you may request a formal appeal. You may request an appeal of a prior Reconsideration or ask for an appeal right away.
A request for an appeal must be in writing and made within 20 days of receiving written notice of the decision you disagree with — either an initial service authorization or the result of the Reconsideration or complaint.
The request should be mailed to:
Division of Children's System of Care
Attention: Appeals Unit
P.O. Box 717
Trenton, NJ 08625-0717
The type of review your appeal will receive depends on the particular service at issue and/or your child's insurance coverage.
Concerns about providers
If you suspect your provider is engaging in fraudulent activity around payments or service delivery, you should call PerformCare right away at 1-877-652-7624. Examples of fraud and abuse include:
- Agreeing to provide a service before it has been authorized by PerformCare.
- Asking you to sign off on participating in services or visits that have not yet occurred.
- Offering you gifts or money to receive treatment or services.
For more details about submitting a complaint, requesting a Reconsideration, filing an appeal, or reporting possible provider fraud and abuse, please call PerformCare at 1-877-652-7624 or refer to the New Jersey Children's System of Care Youth and Family Guide (PDF).