Provider Dispute Resolution Process Sample Clauses

Provider Dispute Resolution Process. The CHC-MCO must develop, implement, and maintain a Provider Dispute Resolution Process, which provides for informal resolution of Provider Disputes at the lowest level and a formal process for Provider Appeals. The CHC-MCO and the Provider must handle the resolution of all issues regarding the interpretation of Provider Agreements and shall not involve the Department; therefore, Provider disputes and appeals are not within the jurisdiction of the Department’s BHA. Prior to implementation, the CHC-MCO must submit to the Department its policies and procedures for resolution of Provider Disputes and Provider Appeals for approval. The CHC-MCO’s Provider Disputes and Provider Appeals policies and procedures must include, at a minimum: • Informal and formal processes for settlement of Provider Disputes. • Acceptance and usage of this Agreement’s definition of Provider Appeals and Provider Disputes. • Time frames for submission and resolution of Provider Disputes and Provider Appeals. • Processes to provide equitability for all Providers. • Mechanisms and time frames for reporting Provider Appeal decisions to CHC- MCO administration, QM, Provider Relations, and the Department. • Establishment of a CHC-MCO Committee to process formal Provider Appeals, which must provide: – At least one-fourth (1/4th) of the membership of the Committee must be composed of Providers/peers. – Committee members who have the authority, training, and expertise to address and resolve Provider Dispute/Provider Appeal issues. – Access to data necessary to assist Committee members in making decisions. – Documentation of meetings and decisions of the Committee.
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Provider Dispute Resolution Process. The Contractor must submit to the Department copies of the completed Provider Dispute Resolution System Quarterly and Annual Reports relating to Provider specific disputes and resolutions.
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Provider Dispute Resolution Process. 6.4.1 TSS has established a procedure to resolve billing, payment, and other administrative disputes between Providers and TSS arising under this Addendum including a Provider Complaint resolution process implemented by TSS to address, among others, lost or incomplete Claims forms or electronic submissions; TSS’ requests for additional explanation as to services or treatment rendered by a Provider; and inappropriate or unapproved Referrals issued by Providers. This dispute resolution process shall exclude Grievances filed by Providers on behalf of Enrollees pursuant to Section 14.3 of the GHP Program Contract. 6.4.2 For any dispute between the Provider and TSS arising under this Addendum, TSS has implemented an internal dispute resolution system, which includes the opportunity for the Participating Provider to submit a timely written complaint to TSS. TSS shall issue a written decision on the Provider’s complaint within fifteen
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Related to Provider Dispute Resolution Process

  • Dispute Resolution Process Any claim, dispute or other matter in question not resolved by the process identified in Paragraph

  • CENTRAL DISPUTE RESOLUTION PROCESS The following process pertains exclusively to disputes and grievances on central matters that have been referred to the central process. In accordance with the School Board Collective Bargaining Act, 2014 central matters may also be grieved locally, in which case local grievance processes will apply. In the event that central language is being grieved locally, the local parties shall provide the grievance to their respective central agents.

  • Informal Dispute Resolution Process 1. In the event there is a dispute under this Centralized Contract, the Contractor, OGS and Authorized User agree to exercise their best efforts to resolve the dispute as soon as possible. The Contractor, OGS and Authorized User shall, without delay, continue to perform their respective obligations under this Centralized Contract which are not affected by the dispute. Primary responsibility for resolving any dispute arising under this Centralized Contract shall rest with the Authorized User’s Contractor Coordinators and the Contractor’s Account Executive and the State & Local Government Regional General Manager. 2. In the event the Authorized User is dissatisfied with the Contractor’s Products provided under this Centralized Contract, the Authorized User shall notify the Contractor in writing pursuant to the terms of the Contract. In the event the Contractor has any disputes with the Authorized User, the Contractor shall so notify the Authorized User in writing. If either party notifies the other of such dispute, the other party shall then make good faith efforts to solve the problem or settle the dispute amicably, including meeting with the party’s representatives to attempt diligently to reach a satisfactory result through negotiation. 3. If negotiation between the Contractor and Authorized User fails to resolve any such dispute to the satisfaction of the parties within fourteen (14) business days or as otherwise agreed to by the Contractor and Authorized User, of such notice, then the matter shall be submitted to the State's Contract Administrator and the Contractor’s senior executive officer representative. Such representatives shall meet in person and shall attempt in good faith to resolve the dispute within the next fourteen (14) business days or as otherwise agreed to by the parties. This meeting must be held before either party may seek any other method of dispute resolution, including judicial or governmental resolutions. Notwithstanding the foregoing, this section shall not be construed to prevent either party from seeking and obtaining temporary equitable remedies, including injunctive relief. 4. The Contractor shall extend the informal dispute resolution period for so long as the Authorized User continues to make reasonable efforts to cure the breach, except with respect to disputes about the breach of payment of fees or infringement of its or its licensors’ intellectual property rights.

  • Customer Service, Dispute Resolution If you have a question about your XOOM charges or service you may contact XOOM directly by calling ▇-▇▇▇-▇▇▇-▇▇▇▇ Monday – Friday 8 (eight) a.m. to 11 (eleven)p.m.

  • Dispute Resolution Procedure Any disputes regarding this clause or any matter relating to the use of an electronic access control system shall be dealt with under clause 11 - Disputes Resolution Procedure.