Common use of Ombudsman Program Clause in Contracts

Ombudsman Program. An Ombudsman Program will be available to all members of QExA. The purpose of the program is to ensure access to care, to promote quality of care, and to strive to achieve recipient satisfaction with QExA. The Department of Human Services (DHS) will seek a qualified independent organization to assist and represent members in the resolution of problems and conflicts between the health plan and its members regarding QExA services to act as the Ombudsman prior to the initial date for delivery of services. Issues regarding a member’s health plan enrollment prior to the initiation of services will be handled by the enrollment counselor described in STC 28.