Grievances and Appeals a. If you have questions about any pediatric dental services received, please first discuss the matter with your Dental Provider. However, if you continue to have concerns, please call Delta Dental’s Customer Service Center. You can also email questions by accessing the “Contact Us” section of the dental plan website at xxx.xxxxxxxxxxxxxx.xxx.
Grievances and Appeals. MAO shall implement the applicable requirements of 42 CFR 422.562(a)(5), and any subsequent regulatory guidance relating to assistance with Medicaid covered service grievances and appeals as detailed in paragraph 2.14 of this Agreement. MAO shall submit Grievances and Appeals reports quarterly in accordance with the requirements of Attachment 1: Chart of Deliverables using the format provided by AHCCCS. AHCCCS shall use these reports for informational purposes only. MAO shall provide AHCCCS with the following information: • A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals; • A quarterly summary of Medicare Independent Review Entity (IRE) decisions received; and • Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).
Grievances and Appeals. 19.1 42 C.F.R. § 438.400 defines the term “grievance” to mean an expression of dissatisfaction about any matter other than an Adverse Benefit Determination. It includes, but is not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, failure to respect the beneficiary’s rights regardless of whether remedial action is requested, and the beneficiary’s rights to dispute an extension of time proposed by the MHP to make an authorized decision.
Grievances and Appeals. No salary adjustments under Section C.4 of this Article may be grieved under this Agreement or under any previous Agreement. This prohibition precludes grievances under all other provisions of this and previous Agreements.
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Grievances and Appeals iii. When appropriate, notify the rendering provider of the authorization decision. Notices to providers need not be in writing.
Grievances and Appeals. 2.6.5.1. The Contractor shall comply with 10 CCR 2505-10, Section 8.209, of the Medicaid state rules for Managed Care Grievance and Appeals Processes. The Contractor shall participate in all State fair hearings regarding appeals and other matters arising under this contract.
Grievances and Appeals. Participants and Preferred Providers may submit grievances and appeal qualified ACO decisions in accordance with the ACO Appeals Policy, available on the ACO Provider Portal and incorporated herein by reference.
Grievances and Appeals. The MCO’s grievance and appeals procedures must be understandable and accessible to Medicaid enrollees and must comply with federal requirements and West Virginia Statutes 33- 25A-12, and must be approved in writing by the Department (42 CFR 434.32).
Grievances and Appeals. PROVIDER agrees to comply with, and participate in, the mechanism for grievances and appeals to be developed or adopted by IEFMC which allows physicians the opportunity to resolve disputes regarding professional medical services, utilization review determinations and other grievances.
