Handling of Grievances and Appeals Sample Clauses

Handling of Grievances and Appeals. The Contractor shall adhere to the following record keeping, monitoring, and review requirements:
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Handling of Grievances and Appeals. The grievance and appeal procedures shall be governed by the following requirements:
Handling of Grievances and Appeals. 43 9.5.1 General Requirements 43 9.5.2 Special Requirements for Appeals 44 9.6 Notice of Action 45 9.6.1 Language and Format Requirements 45 9.6.2 Content of Notice 45 9.6.3 Timing of Notice 45 9.7 Resolution and Notification 46 9.7.1 Specific Timeframes 47 9.7.2 Extension of Timeframes 47 9.7.3 Format of Notice 47 9.7.4 Content of Notice of Appeal Resolution 48 9.7.5 Requirements for State Fair Hearings 48 9.8 Expedited Resolution of Appeals 48 9.8.1 Punitive Action 48 9.8.2 Action Following Denial of a Request for Expedited Resolution 49 9.8.3 Failure to Make a Timely Decision 49
Handling of Grievances and Appeals. The Health Plan’s policies and procedures for handling Grievances and Appeals shall include the following requirements:
Handling of Grievances and Appeals. (42 CFR §438.406).

Related to Handling of Grievances and Appeals

  • 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.

  • Processing of Grievances (a) Shop stewards shall suffer no loss in pay for the time spent processing grievances or attending meetings with the Employer's representative.

  • Settling of Grievances An xxxxxxx effort shall be made to settle grievances fairly and promptly in the following manner:

  • Investigation of Grievances The investigation of grievances shall not interfere with the orderly process of education in District 281.

  • Processing of Grievance It is recognized and accepted by the Union and the County that the processing of grievances as hereinafter provided is limited by the job duties and responsibilities of the employees and shall therefore be accomplished during normal working hours only when consistent with such employee duties and responsibilities. The aggrieved employee's representative, if an employee, shall be allowed a reasonable amount of time without loss in pay, to investigate a grievance, and present grievances to the County during normal working hours provided the employee and the employee representative have notified the designated supervisor.

  • Submission of Grievances A. Any employee or group of employees shall have the right to present a grievance. No employee or group of employees shall be hindered from or disciplined for exercising this right.

  • COMPLAINTS AND APPEALS As a Premera member, you have the right to offer your ideas, ask questions, voice complaints and request a formal appeal to reconsider decisions we have made. Our goal is to listen to your concerns and improve our service to you. If you need an interpreter to help with oral translation, please call us. Customer Service will be able to guide you through the service. WHEN YOU HAVE IDEAS We would like to hear from you. If you have an idea, suggestion, or opinion, please let us know. You can contact us at the addresses and telephone numbers found on the back cover. WHEN YOU HAVE QUESTIONS Please call us when you have questions about a benefit or coverage decision, our services, or the quality or availability of a healthcare service. We can quickly and informally correct errors, clarify benefits, or take steps to improve our service. We suggest that you call your provider of care when you have questions about the healthcare they provide.

  • 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.

  • Grievances and Complaints 5.1 It is the mutual desire of the parties hereto that grievances and complaints relative to this Agreement or working conditions generally shall be adjusted as quickly as possible.

  • Settlement of Grievances The applicable procedures of this Agreement shall be followed for the settlement of all grievances. All grievances shall be considered carefully and processed promptly.

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