Prior to setting a formal hearing, the CFO or designee shall attempt to resolve the appeal informally. The CFO or designee shall first refer the hearing request to a CSS contract officer.

The contract officer, accompanied by a division representative selected by the division director or designee, shall make initial inquiries into the complainant's situation. The contract officer and division representative shall interview both the provider representative and the complainant and review pertinent records of both. Based on the findings, the contract officer shall compile a report outlining the problems and proposing solutions. The contract officer shall submit the report to the CFO or designee within 15 working days of receipt of the request for a hearing.

The CFO or designee and the division director shall review the report and submit recommendation for resolving the problem to the contract officer within 15 calendar days from date of receipt of the report.

The contract officer shall present the proposed solution to the complainant and provider representative within 5 working days of the date the contract officer received the proposed solution. If the solution is satisfactory to the complainant and provider representative, no formal hearing is required. The contract officer shall obtain the signature of the complainant on the document detailing the proposed solution. Contract officer shall provide copies of the signed document to the complainant, provider representative, and division representative and shall submit the original signed document to the CFO or designee. CFO or designee shall file the original signed solution in a hearing file.

If the proposed solution from the informal review is not acceptable to the complainant, he/she may file a request for a formal appeal utilizing the Administrative Appeals and Hearings procedure.