External Grievance definition

External Grievance. A Grievance that is filed with CMS and/or the State. This is not an Appeal.
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External Grievance. The Contract shall inform Enrollees that they may file an external grievance for Medicare only covered benefits and services through 1-800 Medicare or for Medicare and Medi-Cal covered benefits and services through the Cal MediConnect Ombuds program. The Contractor must display a link to the electronic grievance form on the Xxxxxxxx.xxx Internet Web site on the Contractor’s main web page. 42 C.F.R. § 422.504(a)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll-free telephone number where an Enrollee grievance may be filed.
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External Grievance. A grievance that is filed with CMS and/or the State. Flexible Benefits – Benefits MMPs may choose to offer outside of the required Covered Services. Long-Term Services and Supports (LTSS) – A range of medical, social, or rehabilitation services a person needs over months or years in order to improve or maintain function or health, which are provided in the community or in a long-term care facility such as a nursing facility. Grievance – In accordance with 42 CFR Part 438.400, grievance means an expression of dissatisfaction about any matter other than an “Action.” A grievance is filed and decided at the MMP level. Possible subjects for grievances include, but are not limited to, the quality of care or services provided and aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect the Enrollee’s rights. Healthcare Effectiveness Data and Information Set (HEDIS) – Tool developed and maintained by the National Committee for Quality Assurance that is used by health plans to measure performance on dimensions of care and service in order to maintain and/or improve quality.
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Examples of External Grievance in a sentence

  • External Grievance Process: If dissatisfied with the decision rendered in a Formal Internal Review, the Covered Person may pursue an External Review before an independent review organization.

  • External Grievance Appeal Reviews Issues involving medical judgment (Grievance) or a rescission of coverage (except for non-payment of premiums) are coordinated by the plan in full compliance with the federally administered private accredited Independent Review Organization (IRO) process as required by Health Care Reform.

  • External Grievance Procedure Any student, parent or employee who chooses not to use the Collaborative's internal grievance procedures or who is not satisfied with the Collaborative's internal grievance procedures may file a complaint of discrimination or harassment with an appropriate state or federal agency.

  • The External Grievance Officer is a person of demonstrable authority and experience in Higher Education, who is not otherwise employed by SCD or any MI.

  • The Internal (Worker) and External Grievance Mechanisms will be implemented by relying on the following key principles for all the Project-related comments, issues, and complaints internally and externally.

  • The builder S advised that the Architects should have included the professional fees in their quotation when they sent the building costs to the QS for a final analysis.

  • The general purpose of this document is to outline the formal procedure of Alba’s External Grievance Mechanism to manage E&S grievances for Line 6 Expansion Project, hereafter known as the Project.

  • The process flow of the External Grievance Mechanism is explained below in the Alba External Grievance Mechanism Flowchart.

  • The External Grievance Mechanism can be used by all (members of) communities affected by Alba’s E&S performance and applies to all stakeholders of Alba.

  • The Plan shall contact the Member or the Health Care Provider who filed the External Grievance Appeal and the Department of Health within five (5) business days of the filing of the External Grievance Appeal.


More Definitions of External Grievance

External Grievance. A Grievance that is filed with CMS and/or the State. This is not an Appeal. Facility-based Long-Term Services and Supports (LTSS) – Facility-based LTSS are a range of medical, social, habilitation or rehabilitation services a person needs over months or years in order to improve or maintain function or health which are provided in a long-term care facility such as a nursing home or intermediate care facility, ICF-IID (not including Assisted Living Residences). FIDA Administrative Hearing Unit – The unit within the New York State Office of Temporary and Disability Assistance which reviews adverse decisions made by FIDA Plan. FIDA-IDD Comprehensive Service Planning Assessment – A systematic evaluation of the Participant’s care and service needs as further described herein. The FIDA-IDD Comprehensive Service Planning Assessment will be conducted using the “It’s All About Me” (IAM) tool. The FIDA-IDD Plan, as part of the care planning process, will complete the IAM, a person-centered assessment written in person-first language which describes the functional status, needs and wishes of a person with IDD across 24 domains and determines a recommended list of actions based on the person’s current status. Among the domains covered by IAM are the following: social, functional, medical, behavioral, wellness and prevention domains, caregiver’s status and capabilities, as well as the Participant’s preferences, strengths, and goals. The FIDA-IDD Plan’s Assessment RN shall use relevant and comprehensive data sources when completing the IAM, including the Participant, Providers, and their caregivers, Representatives, or designees. The IAM results, in addition to the results of the OPWDD Approved Assessment (the Coordinated Assessment System), will be used as the basis for developing the integrated, LP. Fully-Integrated Duals Advantage Individuals with Intellectual and Developmental Disabilities Plan (FIDA-IDD Plan) – A managed care plan under contract with CMS and the State to provide the fully-integrated Medicare and Medicaid benefits, including OPWDD Covered Items and Services, under the FIDA-IDD Demonstration. Grievance – In accordance with 42 CFR Part 438.400, grievance means an expression of dissatisfaction about any matter other than an Action A grievance, and is filed and decided at the FIDA-IDD Plan level. Possible subjects for grievances include, but are not limited to, the quality of care or services provided and aspects of interpersonal relationships such as r...
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External Grievance. A grievance with an adverse decision at the FIDA Plan level that is filed with CMS and/or the State. Facility-based Long-Term Services and Supports (LTSS) – Facility-based LTSS are a range of medical, social, or rehabilitation services a person needs over months or years in order to improve or maintain function or health which are provided in a long term care facility such as a nursing home (not including Assisted Living Residences).
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External Grievance means independent review of a grievance and “Department” is the Indiana department of insurance.
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Related to External Grievance

  • external borders means external borders as defined in point 2 of Article 2 of Regulation (EU) 2016/399;

  • external company means a foreign company that is carrying on business, or non-profit activities, as the case may be, within the Republic, subject to section 23(2);

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • External Verifier means any qualified provider of third party assurance or attestation services or other independent expert of internationally recognised standing appointed by the Issuer, in each case with the expertise necessary to perform the functions required to be performed by the External Verifier under these Conditions, as determined in good faith by the Issuer;

  • External User means a user of an Online Service that is not an employee, onsite contractor, or onsite agent of Customer or its Affiliates.

  • External dose means that portion of the dose equivalent received from any source of radiation outside the body.

  • Internal appeal means an internal appeal to the relevant authority in terms of section 74;

  • Grievance means a dispute arising out of the interpretation, application, administration or alleged violation of the terms of this Agreement.

  • External Auditor as used here shall mean any registered public accounting firm engaged for the purpose of preparing or issuing an audit report or performing other audit, review or attest services for the Company. Each such external auditor shall report directly to the Committee. With respect to the external auditor, the Committee shall:

  • Policy Grievance is defined as a difference between the parties relating to the interpretation, application or administration of this Agreement. A policy grievance may be submitted by either party at Step 2 of the grievance procedure. A policy grievance shall be signed by a CLAC Representative and submitted to the Employer. A policy grievance submitted by the Employer shall be signed by the Employer or his representative.

  • External Manager means either of the following: (1) A person who is seeking to be, or is, retained by a board or an investment vehicle to manage a portfolio of securities or other assets for compensation, or (2) A person who manages an investment fund and who offers or sells, or has offered or sold, an ownership interest in the investment fund to a board or an investment vehicle.

  • Personal Grievance means a claim of unjustifiable dismissal, unjustifiable disadvantage, discrimination, sexual or racial harassment, or duress in relation to membership or non-membership of a union or employees’ organisation.

  • external wall means an outer wall of a building even though adjoining to a wall of another building and also means a wall abutting on an interior open space of a building;

  • External Directors means directors appointed and serving in accordance with Sections 239 through 249 of the Companies Law.

  • External Resource means a generation resource located outside the metered boundaries of the PJM Region.

  • Internal dose means that portion of the dose equivalent received from radioactive material taken into the body.

  • Statement of Grievance shall name the grievant(s) involved, the facts giving rise to the grievance, provision(s) of the Agreement alleged to be violated and the remedy (specific relief) requested.

  • Internal Use means use of the Sprinklr Services for Customer’s and/or Customer Affiliates’ general business use, solely for the benefit of Customer and/or Customer Affiliates, but does not include use of the Sprinklr Services to provide any services for the benefit of third parties.

  • A grievance means a dispute or disagreement as to the interpretation or application of terms and conditions of employment contained in this Agreement.

  • internal waters means any navigable river or waterway within the State of California.

  • Internal combustion engine or ‘engine’ means an energy converter, other than a gas turbine, designed to transform chemical energy (input) into mechanical energy (output) with an internal combustion process; it includes, where they have been installed, the emission control system and the communication interface (hardware and messages) between the engine's electronic control unit(s) and any other powertrain or non-road mobile machinery control unit necessary to comply with Chapters II and III;

  • External Review means an independent review of an Adverse Benefit Determination conducted by an Independent Review Organization.

  • Internal Auditor means the person employed or engaged by the Corporation to perform the internal audit function of the Corporation;

  • external engineering service means an engineering service situated outside the boundaries of a land area and that is necessary to serve the use and development of the land area;

  • External beam radiation therapy means therapeutic irradiation in which the source of radiation is at a distance from the body.

  • Internal Systems means the internal systems of the Company that are used in its business or operations, including, computer hardware systems, software applications and embedded systems.