Common use of Enrollee Appeals and Grievances Clause in Contracts

Enrollee Appeals and Grievances. Internal Grievances and Appeals. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and Participating Providers, including appeals of claim and benefit determinations, and complaints relating to the scope of Covered Services required to be covered under the QDP. Contractor’s processes shall comply with State and Federal laws, rules and regulations relating to enrollee rights and appeals processes, specifically including grievance requirements, set forth at Health and Safety Code § 1368 regardless of the State Regulator for the Contractor’s QDPs.

Enrollee Appeals and Grievances. Internal Grievances and Appeals. Contractor shall maintain an internal review process to resolve Enrollee’s Enrollee¶s written or oral expression of dissatisfaction regarding the Contractor and Participating Providers, including appeals of claim and benefit determinations, and complaints relating to the scope of Covered Services required to be covered under the QDP. Contractor’s processes Contractor¶sprocesses shall comply with State and Federal laws, rules and regulations relating to enrollee rights and appeals processes, specifically including grievance requirements, set forth at Health and Safety Code § §1368 regardless of the State Health Insurance Regulator for the Contractor’s Contractor¶s QDPs.