Notification of Complaint and Appeal Program Clause Samples
The Notification of Complaint and Appeal Program clause establishes the procedures for informing relevant parties when a complaint or appeal is filed within an organization or contractual relationship. Typically, this clause outlines the required method and timeframe for submitting notifications, as well as the parties who must be informed, such as management, compliance officers, or external regulators. Its core function is to ensure transparency and prompt communication, thereby facilitating timely resolution of disputes and maintaining accountability throughout the complaint or appeal process.
Notification of Complaint and Appeal Program a) The Contractor's specific complaint and appeal program shall be described in the Contractor's member handbook and shall be made available to all Enrollees.
b) The Contractor will advise Enrollees of their right to a fair hearing as appropriate and comply with the procedures established by SDOH for the Contractor to participate in the fair hearing process, as set forth in Section 25 of this Agreement. The Contractor will also advise Enrollees of their right to an external appeal, in accordance with Section 26 of this Agreement.
Notification of Complaint and Appeal Program a) The Contractor will advise Enrollees of their right to a fair hearing as appropriate and comply with the procedures established by SDOH for the Contractor to participate in the fair hearing process, as set forth in Section 25 of this Agreement.
b) The Contractor's specific complaint and appeal program shall be described in the Contractor's member handbook and shall be made available to all Enrollees.
c) The Contractor will provide written notice for the Complaint, Complaint Appeal, and fair hearing procedures to all Participating Providers, and subcontractors to whom the Contractor has delegated Complaint Determination procedures, at the time they enter into an agreement with the Contractor:
i) the Enrollee’s right to a fair hearing, how to obtain a fair hearing, and representation rules at a hearing;
ii) the Enrollee’s right to file Complaints and Complaint Appeals and the process and timeframes for filing;
iii) the Enrollee’s right to designate a representative to file Complaints and Complaint Appeals on his/her behalf;
iv) the availability of assistance from the Contractor for filing Complaints and Complaint Appeals; v) the toll-free numbers to file oral Complaints and Complaint Appeals;