Grievance Program definition

Grievance Program means the procedures established by Health Plan to timely address Enrollee and Provider complaints or grievances.
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Grievance Program means the procedures established by Health Plan to timely address Enrollee and Provider complaints or grievances. Molina ECMS ref# 729 Provider or authorized MHC v122706 / MHI v091707 representative’s initials: Pacific Hospital of Long Beach
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Grievance Program means a formalized set of activities designed to provide Members and Providers, exercising their rights under applicable state and federal law, to a fair and solution-oriented process to address a perceived problem with the operations of the PLAN, including delivery and access to care, in a reasonable amount of time. This Program includes provisions for evaluation of complaints, assessments of trends, implementation of actions to correct identified problems, mechanisms to communicate actions and results to the appropriate health plan employees and contracting providers.
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Examples of Grievance Program in a sentence

  • Provider shall participate in Health Plan’s Grievance Program and shall cooperate with Health Plan in identifying, processing, and promptly resolving all Member complaints, grievances, or inquiries.

  • Provider shall implement a Grievance Program that complies with WAC 246- 341, RCW 48.43.055, or its successors and shall participate in MCO’s Grievance Program and cooperate with MCOs in identifying, processing, and promptly resolving all client complaints, grievances, or inquiries.

  • Any claim or controversy arising out of or in connection with this Agreement will be resolved, to the fullest extent possible and in accordance with Law, through the Grievance Program, Health Plan’s internal appeals process, informal meetings and discussions held in good faith between appropriate representatives of the parties.

  • Provider will participate in Health Plan’s Grievance Program and will cooperate with Health Plan in identifying, processing, and promptly resolving all Member complaints, grievances, or inquiries.

  • Hospital will participate in Health Plan’s Grievance Program and will cooperate with Health Plan in identifying, processing, and promptly resolving all Member complaints, grievances, or inquiries.

  • Provider shall implement a Grievance Program that complies with WAC 182-538C 110 or its successors and shall participate in North Sound BH-ASO’s Grievance Program and cooperate in identifying, processing and promptly resolving all individual complaints, grievances, or inquiries.

  • Provider’s failure to exhaust Health Plan’s Appeals and Grievance Program will bar Provider from obtaining other remedies available under this Agreement.

  • Enrollee Grievance Program – A program developed and implemented by Solstice, or its designee, to allow Enrollees to present complaints and grievances related to quality of care, claim denials, and coverage disputes, and the procedures through which effective resolution is sought.

  • Such Protocols are incorporated herein and made part of this Agreement including, but not limited to, those Protocols set forth in the VORG, the credential verification program, the Quality Management Program, the Enrollee Grievance Program, and any other programs established by Solstice.

  • The Commissioner is responsible for the overall operation of the Division’s Inmate Grievance Program and has designated the Deputy Commissioner as the final reviewing authority before execution of a settlement agreement.


More Definitions of Grievance Program

Grievance Program means the procedures established by Health Plan to timely address Member and Provider complaints or grievances. Health Plan means VENTURA COUNTY MEDI-CAL MANAGED CARE COMMISSION, a public entity doing business as Gold Coast Health Plan.
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