Grievance appeals. An employee may appeal his/her dismissal, suspension, or other punitive discipline through the grievance procedure, except that a probationary employee may be separated from service without recourse to the grievance procedure.
Grievance appeals. SCDHHS shall have the right to approve, disapprove or require modification of all grievance procedures submitted with this Contract. SCDHHS requires the Contractor to meet and/or exceed the Medicaid MCO Program grievance standards as outlined in §9.
Grievance appeals. Disputes involving the interpretation, application, or enforcement of the express terms of this article shall be filed within 14 calendar days after receipt of the notice of layoff directly at Step 2 (Section 5.10) of the Article V, Grievance and Arbitration Procedure, of this agreement.
Grievance appeals. Failure of an employee or the Association to act on any grievance within the time limits will act as a bar to any further appeal, and the employer's failure to give a decision within the time limits shall permit the grievance to proceed to the next step. The time limits, however, may be extended by mutual agreement.
Grievance appeals appeals where the individual remains dissatisfied after a reconsideration by the Chief Executive or where the Chief Executive refers the matter directly; and
Grievance appeals. A grievance/appeal may be filed due to non-medical services, administrative grievances which include denial of payment, an adverse determination or other dissatisfaction with the Plan within 90 days of the event leading to the grievance/appeal. A Member has the right to have benefits continue pending resolution of the grievance/ appeal. If the denial is upheld, the Member may be required to pay for the benefits. The Member may also authorize a representative to act on their behalf in the grievance/ appeal process. The Member has the right to send additional documentation with the grievance/appeal. At the Member’s request, as a part of the grievance/appeal rights, the Plan can arrange a meeting with the Appeal Review Committee. The Member can discuss the grievance/ appeal with the committee. The Member or authorized representative may attend a meeting in person or by telephone. A person not involved in the first decision can review the grievance/appeal. No one who reports to the person involved in the initial decision can review the grievance/appeal. The person who reviews the grievance/appeal will be of similar specialty. An administrative or non-medical service grievance/appeal will be completed within thirty-five (35) calendar days after it is received. The timeframe may be extended up to 10 business days if the Plan can show that there is need for additional information and can demonstrate that the delay is in the Member’s interest. If the Plan utilizes the extension, the Plan must give the Member written notice of the reason for the delay. The Member will be notified in writing of the final decision. If the decision upholds the denial, an external appeal can be filed. The final letter informs the Member of the external appeal rights and how to file the appeal. External Appeal Rights The Member or authorized representative has the right to request an external review of DIFS. The request can be made after the Plan notifies the Member of the final decision. Notification of the final decision completes the Plan’s internal appeal process. The Member or authorized representative must file the DIFS, Health Care Request for External Review Form FIS0018 to be given an external review. A copy of the Health Care Request for External Review Form will be sent with the final decision letter. The Member may also call DIFS at 0-000-000-0000 to have a form mailed. The form should be filed no later than sixty (60) days after receipt of the final decision letter: Departm...
Grievance appeals. If You are not satisfied with the resolution of Your Grievance, You or Your designee may file an Appeal in writing. You have up to 60 business days from receipt of the Grievance determination to file an Appeal. When We receive Your Appeal, We will mail an acknowledgment letter within 15 business days. The acknowledgement letter will include the name, address, and telephone number of the person handling Your Appeal and indicate what additional information, if any, must be provided. One or more qualified personnel at a higher level than the personnel that rendered the Grievance determination will review it, or if it is a clinical matter, a clinical peer reviewer will look into it. We will decide the Appeal and notify You in writing within the following timeframes: Expedited/Urgent Grievances: The earlier of two (2) business days of receipt of all necessary information or 72 hours of receipt of Your Appeal. Pre-Service Grievances: (A request for a service or treatment that has not yet been provided.) 15 calendar days of receipt of Your Appeal. Post-Service Grievances: (A claim for a service or a treatment that has already been provided.) 30 calendar days of receipt of Your Appeal. All Other Grievances: (That are not in relation To a claim or request for a service or treatment.) 30 business days of receipt of all necessary information to make a determination.
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Grievance appeals. If You are not satisfied with the resolution of Your Grievance, You or Your designee may file an Appeal by phone at the number on Your ID card in person or in writing. You have up to 60 business days from receipt of the Grievance determination to file an Appeal. When We receive Your Appeal, We will mail an acknowledgment letter within 15 business days. The acknowledgement letter will include the name, address, and telephone number of the person handling Your Appeal and indicate what additional information, if any, must be provided. One or more qualified personnel at a higher level than the personnel that rendered the Grievance determination will review it, or if it is a clinical matter, a clinical peer reviewer will look into it. We will decide the Appeal and notify You in writing within the following timeframes: Expedited/Urgent Grievances: The earlier of two (2) business days of receipt of all necessary information or 72 hours of receipt of Your Appeal.
Grievance appeals. In the case of a grievance appeal, the Arbitrator shall not have the power to alter, modify, amend or make any decision inconsistent with the terms of this Agreement.
