Provider Complaint definition

Provider Complaint. A written expression by a Provider, which indicates dissatisfaction or dispute with the Contractor’s policies, procedures, or any aspect of a Contractor’s administrative functions, including a Proposed Action.
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Provider Complaint means a provider’s complaint about the contractor’s performance. Verified provider complaints are used as a measure of the quality of the contractor’s performance under this SOW.
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Examples of Provider Complaint in a sentence

  • Provider complaint reports are submitted to the QI Committee at least quarterly, along with recommendations for QI activities based on results.

  • Provider complaint resolution policies and procedures shall be in writing and approved by the department prior to implementation.

  • Timing Provider complaint systemOHCA may only execute transition to a managed care delivery system ninety (90) days after CMS has approved all contracts entered into between OHCA and all MCOs or DBMs following OHCA's submission of readiness review results to CMS, pursuant to 42 C.F.R. § 438.66.The CE or DBM shall have written provider complaint policies and procedures for an Enrollee, or an Enrollee's authorized representative, to appeal a CE's or DBM's action and/or file a grievance.

  • These aspects are closely linked to the issue of how the various levels of jurisdiction should interact.

  • The Offeror shall have a procedure for expedited review of a Provider complaint if the standard time frame could seriously jeopardize the Member’s life, physical or mental health, or the Member’s ability to regain maximum function.

  • If the Provider complaint is not resolved within thirty (30) Calendar Days, the CONTRACTOR shall request a fourteen (14) Calendar Day extension from the Provider.

  • Any misdirected submissions, including but not limited to Administrative Reviews or Clinical Appeals, into the Provider complaint system will be routed to the appropriate department.The provider will be advised of the redirection and educated on proper handling and contact details of the appropriate department for future reference.

  • All Member Grievance and/or Appeal and Provider complaint files shall be maintained in a secure, designated area and be accessible to HCA upon request, for review.

  • Provider complaint line: By phone toll-free at (877)525-1295By email at plans-providers@dmhc.ca.govM.

  • The Dental Contractor's tracking system must include the status and final disposition of each Provider complaint.

Related to Provider Complaint

  • Product Complaint means any oral, electronic or written communication that alleges deficiencies related to the identity, quality, durability, reliability, safety, effectiveness or performance of a marketed product, including failure of the product, labelling or packaging to meet specifications, whether or not the product is related to or caused the alleged deficiency. A complaint may allege that an Adverse Event or Medical Device Malfunction (as defined herein) has occurred.

  • Service Complaints For service problems or complaints, you should contact your local utility by calling: AEP Ohio at 000.000.0000. IN THE EVENT OF AN ENERGY-RELATED EMERGENCY, SUCH AS A POWER OUTAGE OR DOWNED POWER LINE, PLEASE VACATE THE AREA BY A SAFE DISTANCE AND CALL YOUR LOCAL UTILITY or 911. Authorization/Representation/Letter of Agency:By entering into this Agreement, you authorize XOOM to act on your behalf under your local utility’s tariffs in accordance with the rules and regulations of the PUCO. You acknowledge that you are your local utility account holder, or a person legally authorized to execute this Agreement on behalf of the account holder for electricity service and are at least eighteen (18) years of age. You agree to authorize XOOM to obtain your credit information and you agree to authorize your local utility to release all information relating to your historical and current electricity usage, billing and payment history to XOOM or its authorized representatives. You acknowledge that XOOM has full authority to make all rates and tariff selections necessary to meet its obligations under this Agreement. You may rescind this authorization at any time by contacting XOOM. Neither your social security number, customer account number nor any other customer financial information will be released by XOOM, except where such release is required by court order or by Commission Order or Rule, without your affirmative written consent. Execution of this Agreement shall constitute authorization for the release of this information to XOOM.

  • Complaints means each of the following documents:

  • Provider Service means a Provider’s hosted online services (if any) as described in the Solution Exhibit which is provided by Provider to Customers located in the Territory through remote access via the Internet as part of the BPO Service. A Provider Platform Application shall be considered a Provider Service.

  • Provider is any individual or company that provides professional or technical services.

  • Complaint means any formal written complaint raised by a Contracting Body in relation to the performance of this Framework Agreement or any Call-Off Contract in accordance with Clause 44 (Complaints Handling and Resolution);

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,

  • Policy Grievance is defined as a difference between the parties relating to the interpretation, application or administration of this Agreement. A policy grievance may be submitted by either party at Step 2 of the grievance procedure. A policy grievance shall be signed by a CLAC Representative and submitted to the Employer. A policy grievance submitted by the Employer shall be signed by the Employer or his representative.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Formal complaint means a document filed by a complainant or signed by the Title IX Coordinator alleging sexual harassment against a respondent and requesting an investigation of the allegation of sexual harassment.

  • Complaint Investigation means an investigation of any complaint that has been made to a proper authority that is not covered by an abuse investigation.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Provider Group means a medical group, independent

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • ProviderOne or “P1” means the system commonly referred to as the Medicaid Management Information System (MMIS), and is the federally approved system used by the Washington Medicaid program to pay provider claims for goods and services authorized under the State Plan. The MMIS is certified by CMS and is the primary information system used by HCA to pay for health care.

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Environmental Complaint shall have the meaning set forth in Section 4.19(d) hereof.

  • Provider fee means the consideration paid for a service contract.

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • A grievance means a dispute or disagreement as to the interpretation or application of terms and conditions of employment contained in this Agreement.

  • HMO means health maintenance organization.

  • Enrollee means any person entitled to health care services from a carrier.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Contractor Related Parties means any affliates of the Contractor and the Contractor's executive officers, Pennsylvania officers and directors, or owners of 5 percent or more interest in the Contractor.

  • Enhanced 911 Service (“E911”) means a telephone communication service which will automatically route a call dialed “9-1-1” to a designated public safety answering point (PSAP) attendant and will provide to the attendant the calling party’s telephone number and, when possible, the address from which the call is being placed and the Emergency Response agencies responsible for the location from which the call was dialed.