Expedited Grievance or Appeal Sample Clauses

Expedited Grievance or Appeal. An emergency or urgent situation in which a member or their authorized representative requests a review of a situation where further delay could be a health risk to the member, as verified by a medical professional. Experimental Surgery and Procedures: Experimental services that meet the definition of Wis. Adm. Code DHS 107.035(1) and (2) as determined by the Department.
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Expedited Grievance or Appeal. An emergency or urgent situation in which a member or their authorized representative requests a review of a situation where further delay could be a health risk to the member, as verified by a medical professional. Experimental Surgery and Procedures: Experimental services that meet the definition of Wis. Adm. Code DHS 107.035(1) and (2) as determined by the Department. Formally Enrolled with a Continuing Care Provider (as cited in 42 CFR 441.60(d)): A member, member’s guardian, or authorized representative agrees to use one continuing care provider as the regular source of a described set of services for a stated period of time. ForwardHealth interChange: ForwardHealth interChange is a new system which replaces the Medicaid Management Information System (MMIS), which has been in place since 1977. It is based on a tested and federally certified system already operating in several other states. ForwardHealth interChange handles claims, prior authorizations, and other services for many of the state health care programs within a single system. Throughout this contract, the system is referred to as “interChange.” Fraud: An intentional deception or misrepresentation made by a person or entity with the knowledge that the deception could result in some unauthorized benefit to him/herself, itself or some other person or entity. It includes any act that constitutes fraud under applicable federal or state law.
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Expedited Grievance or Appeal. An emergency or urgent situation in which a member or their authorized representative requests a review of a situation where further delay could be a health risk to the member, as verified by a medical professional. Experimental Surgery and Procedures: Experimental services that meet the definition of Wis. Adm. Code DHS 107.035(1) and (2) as determined by the Department. Formally Enrolled with a Continuing Care Provider (as cited in 42 CFR 441.60(d)): A member, member’s guardian, or authorized representative agrees to use one continuing care provider as the regular source of a described set of services for a stated period of time. ForwardHealth interChange: ForwardHealth interChange handles claims, prior authorizations, and other services for many of the state health care programs within a single system. Throughout this contract, the system is referred to as “interChange.” Fraud: An intentional deception or misrepresentation made by a person or entity with the knowledge that the deception could result in some unauthorized benefit to him/herself, itself or some other person or entity. It includes any act that constitutes fraud under applicable federal or state law.
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Related to Expedited Grievance or Appeal

  • Expedited Appeal An Appeal of a review of continued or extended health care services, additional services rendered in the course of continued treatment, home health care services following discharge from an inpatient Hospital admission, services in which a Provider requests an immediate review, or any other urgent matter will be handled on an expedited basis. An expedited Appeal is not available for retrospective reviews. For an expedited Appeal, Your Provider will have reasonable access to the clinical peer reviewer assigned to the Appeal within one (1) business day of receipt of the request for an Appeal. Your Provider and a clinical peer reviewer may exchange information by telephone or fax. An expedited Appeal will be determined within the earlier of 72 hours of receipt of the Appeal or two

  • GRIEVANCE ARBITRATION PROCEDURE The grievance-arbitration procedure set forth in Sections 16.32 through 16.38 shall be applicable only to disputes arising under Division C of this article.

  • Submission of Grievance 1. Before a submission of a written grievance, the aggrieved party must attempt to resolve the grievance informally with the grievant's immediate supervisor.

  • Formal Grievance Procedure 1. In the event that a complaint cannot be resolved informally, the parties shall pursue the first step in the formal grievance procedure before making any application for arbitration, unless the College and the AAUP agree in writing to alter the procedure or waive one or more of the steps by proceeding directly to arbitration.

  • GRIEVANCE PROCEDURE & ARBITRATION 36.01 Any complaint, disagreement or difference of opinion between the Company and the Union, or the employees, which concerns the interpretation, application, operation or alleged violation of the terms and provisions of this Agreement, shall be considered as a grievance.

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. Complaints A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • GRIEVANCE PROCEDURE 7.01 For purposes of this Agreement, a grievance is defined as a difference arising between the parties relating to the interpretation, application, administration or alleged violation of the Agreement including any question as to whether a matter is arbitrable.

  • GRIEVANCE PROCEDURE 7 Section 4.1. Definition 7 Section 4.2. Procedures 7 Section 4.3. Limitations on Authority of Arbitrator 8 Section 4.4. Expenses of Arbitration 9 Section 4.5. Union Grievances 9 Section 4.6. Time Limits 9 Section 4.7. Miscellaneous 10 Section 4.8. Discipline 10 Section 4.9. Oral or Written Reprimands 11 Section 4.10. Applicability of Grievance and Arbitration Procedure to Discipline 11 ARTICLE V LABOR-MANAGEMENT COMMITTEE 12 ARTICLE VI SENIORITY, LAYOFF AND RECALL 13 Section 6.1. Definition 13 Section 6.2. Probationary Period 13 Section 6.3. Layoff and Recall 13 Section 6.4. Seniority List 15 Section 6.5. Posting of Certain Training Opportunities 15 Section 6.6. Termination of Seniority 15 Section 6.7. Reemployment After Expiration of Right to Recall 16 ARTICLE VII HOURS OF WORK AND OVERTIME 17 Section 7.1. Purpose 17 Section 7.2. Normal Work Cycle 17 Section 7.3. A Day Trades 18 Section 7.4. Overtime 19 Section 7.5. Changing or Trading Tours of Duty 19 Section 7.6. Hireback Procedure 19 Section 7.7. Compensatory Time 20 Section 7.8. Call-Back Pay 21 Section 7.9. No Pyramiding 21 ARTICLE VIII SALARIES AND OTHER COMPENSATION 22 Section 8.1. Salaries 22 Section 8.2. Longevity Pay 24 Section 8.3. Out of Classification Pay 25 Section 8.4. Paramedic Stipend 25 Section 8.5. Paramedic Preceptor 25 ARTICLE IX VACATIONS 26 Section 9.1. Amount of Vacation 26 Section 9.2. Vacation Eligibility 26 Section 9.3. Vacation Scheduling 26 Section 9.4. Limitation on Accumulation of Vacation 27 Section 9.5. Pay Upon Separation 28 Section 9.6. Vacation Day Trades 28 ARTICLE X HOLIDAYS 29 Section 10.1. Holidays for Employees Assigned to 8-Hour Shifts. 29 Section 10.2. Holidays for Employees Assigned to 24-Hour Shifts 30 Section 10.3. Pay for Hirebacks on Holidays 30 ARTICLE XI INSURANCE 31 Section 11.1. Caferteria Benefits Plan 31 Section 11.2. Retirees Insurance 31 Section 11.3. Flexible Benefits Plan 31 Section 11.4. Right to Change Carriers 31 Section 11.5. Terms of Policies to Govern 32 Section 11.6. Right to Maintain Coverage While on Unpaid Leave or on Layoff 32 Section 11.7. Post Retirement Health Savings Plan 32 ARTICLE XII LEAVES OF ABSENCE 33 Section 12.1. Jury Duty 33 Section 12.2. Sick Leave 33 Section 12.3. Special Leaves Without Pay 34 Section 12.4. Bereavement Leave 34 Section 12.5. Emergency Leave for Illness/Injury in Immediate Family 34 Section 12.6. Witness Leave 35 Section 12.7. Family and Medical Leave Act of 1993 36 Section 12.8. Pregnancy Leave/Maternity Leave 36 ARTICLE XIII SAFETY COMMITTEE 37 ARTICLE XIV MAINTENANCE OF SPECIFIC WORKING CONDITIONS 38 ARTICLE XV MISCELLANEOUS FRINGE BENEFITS 39 Section 15.1. Deferred Compensation Plan 39 Section 15.2. Credit Union 39 Section 15.3. Tuition Reimbursement 39 Section 15.4. Quartermaster System and Maintenance Allowance 39 Section 15.5. Sick Leave Incentive Plan 39 Section 15.6. Pay for Unused Sick Leave at Retirement 40 Section 15.7. Severance Pay 40 Section 15.8. Inoculations 40 Section 15.9. Eye Glass Replacement 41 ARTICLE XVI MISCELLANEOUS 42 Section 16.1. Outside Employment 42 Section 16.2. Pay Advance 42 Section 16.3. Gender of Words 42 Section 16.4. Physical Examinations 42 Section 16.5. Job Descriptions 42 Section 16.6. Posting of Formal Training Opportunities 43 Section 16.7. Released Time 43 Section 16.8. Resolution of Impasse 43 Section 16.9. Solicitation 43 Section 16.10. Physical Fitness Program 44 Section 16.11. Shift/Station Selection Process 44 Section 16.12. Subcontracting 48 ARTICLE XVII RIGHTS OF VILLAGE 49 ARTICLE XVIII NON-INTERRUPTION OF WORK 50 Section 18.1. No Strikes 50 Section 18.2. No Lockouts 50 ARTICLE XIX PROMOTIONS 51 Section 19.1. General 51 Section 19.2. Eligibility Requirements 51 Section 19.3. Components of the Promotional Process and the Weighting of Components 52 Section 19.4. Promotion Process Components 53 Section 19.5. Promotions Coordinator 58 Section 19.6. Monitors 58 Section 19.7. Scoring of Components and Posting of Preliminary Promotion List 59 Section 19.8. Veteran's Preference Points and Posting of Final Promotion List 59 Section 19.9. Order of Selection 60 Section 19.10. Duration of Final Promotion List 61 Section 19.11. Right to Review 61 ARTICLE XX SAVINGS CLAUSE 63 ARTICLE XXI ENTIRE AGREEMENT 64 ARTICLE XXII DRUG AND ALCOHOL TESTING 65 ARTICLE XXIII DURATION AND TERM 67 Section 23.1. Term of Agreement 67 Section 23.2. Continuing Effect 67 APPENDIX A VARIANCES FROM STATUTORY IMPASSE PROCEDURE 00 XXXXXXXX X ESSENTIAL JOB FUNCTIONS TESTING 69 APPENDIX C FIRE CHIEF’S EVALUATION INSTRUMENT 75 APPENDIX D VILLAGE’S CAFETERIA BENEFITS PLAN 00 XXXXXXXX X ADDITIONAL QUARTERMASTER ITEMS 77 APPENDIX F CURRENT LIST OF 40 HOUR OR LONGER OFFICE OF STATE FIRE MARSHAL COURSES 78 OCTOBER 23, 1990 MINIMUM STAFFING SIDE LETTER… 80 AGREEMENT This Agreement is made and entered into by and between the Village of Schaumburg (hereinafter referred to as the “Village”) and the Schaumburg Professional Firefighters Association, IAFF Local 4092 (hereinafter referred to as the “Union”).

  • Grievance Arbitration Notwithstanding any other provision of this Agreement, for the purposes of this Article, an Employee has the right to grieve any filling of a vacancy or Assignment in the bargaining unit.

  • GRIEVANCE PROCEDURE 6 Section 3.01 Definitions 6 Section 3.02 Procedure 6 Section 3.03 Other Conditions 7 Article IV. LEAVES 8 Section 4.01 Sick Leave 8 Section 4.02 Bereavement Leave 9 Section 4.03 Personal Leave 9 Section 4.04 Leave Without Pay 9 Section 4.05 Association Leave 10 Section 4.06 Leave Day Calculation 10 Article V. EARNED VACATION DAYS, HOLIDAYS, AND E- LEARNING DAYS 10 Section 5.01 Earned Vacation Days 10 Section 5.02 Recognized Holidays 10 Section 5.03 E-Learning Days 11 Article VI. MEDICAL INSURANCE 11 Section 6.01 Premium Cost 11 Section 6.02 Insurance Committee 11 Article VII. SENIORITY, TRANSFERS, VACANCIES AND LAYOFFS 11 Section 7.01 Definition of Seniority 11 Section 7.02 Probationary Employees 12 Section 7.03 Classifications Without Bargaining Unit 12 Section 7.04 Seniority List 12 Section 7.05 Termination of Seniority 12 Section 7.06 Transfer to New Position 12 Section 7.07 Posting of Vacancies 13 Section 7.07A Posting of Vacancies – Bus Routes 13 Section 7.07B Trips 13 Section 7.08 Filling of Vacancies 14 Section 7.09 Layoffs, Reduction in Force and Elimination of Positions 14 Section 7.10 Recall From Layoff, Reduction in Force Elimination of Positions 15 Section 7.11 Notification of Tentative Assignment 15 Article VIII. PERSONNEL FILE 15 Section 8.01 General 15 Section 8.02 Right to Access 15 Section 8.03 Copies of Documents 15 Article IX. EVALUATION PROCEDURES 15 Section 9.01 Review of Procedures 15 Section 9.02 Informal Observations 16 Section 9.03 Formal Evaluations 16 Section 9.04 Post-Evaluation Procedures 16

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