Potential Quality Issue Form

If you previously submitted a PQI form, navigate to the PQI Status.

Before you begin, please select the reason you'd like to complete this form. (Required)

Report Fraud, Waste, and Abuse for services not rendered, misrepresentation of services, forgery, medically unnecessary or excessive services, overcharging, and conflict of interest.

Report a Complaint related to an MTF.

Report a Complaint or Grievance regarding non-MTF staff rudeness, office cleanliness, office wait times, discrimination, etc.

Report a Potential Quality Issue when you have concerns about the quality of care performed by a TriWest Healthcare Alliance provider.