Common use of Internal Clause in Contracts

Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints relating to the scope of Covered Services required to be provided under the QHP. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368.

Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, including, those and complaints relating to the scope of Covered Services required to be provided under the QHP. and/or relating to Medical Necessity. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368.