Grievance Program definition

Grievance Program means the procedures established by Health Plan to timely address Member 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.
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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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Examples of Grievance Program in a sentence

  • 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 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.

  • 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 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.

  • 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.

  • To request a formal grievance review from the Blue Cross and Blue Shield Member Grievance Program, you (or your authorized representative) have three options.

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

  • 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.

  • 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.


More Definitions of Grievance Program

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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Grievance Program means the procedures established by Health Plan to timely address Enrollee and Provider complaints or grievances. HSA — Hospital Services Agreement Molina ECMS ref# 729 Provider or authorized MHC v122706 / MHI v091707 representative’s initials: Pacific Hospital of Long Beach
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Related to Grievance Program

  • Grievance Procedure is used in this Agreement, it shall be considered as including the arbitration procedure.

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

  • Grievance System means the overall system that includes:

  • 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.

  • 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.

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Grievance Committee means the Grievance Committee of the Bar.

  • Disciplinary sanction means any action listed in s. UWS 14.04 taken in response to student academic misconduct.

  • Compliance Program means the program established by CNYCC to prevent, detect, and address compliance issues that arise with respect to PPS operations, projects or activities.

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

  • Multidisciplinary team means a membership of individuals who possess knowledge and skills related to the diagnosis, assessment, and disposition of dependent adult abuse cases and who are professionals practicing in the disciplines of medicine, public health, social work, law, law enforcement and other disciplines relative to dependent adults. Members of the team shall include, but are not limited to, persons representing the area agencies on aging, county attorneys, health care providers, and others involved in advocating or providing services for dependent adults.

  • PACE program means a program implemented by a municipality to stimulate energy efficiency and renewable energy projects in conformity with Act 270.

  • 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.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Disciplinary Committee means any person or committee of persons, or any subcommittee thereof, that is author- ized by a self-regulatory organization to issue disciplinary charges, to con- duct disciplinary proceedings, to settle disciplinary charges, to impose dis- ciplinary sanctions or to hear appeals thereof.

  • Grievances filed under this Article shall begin at Step 2. Grievances under this clause shall be handled with all possible confidentiality and dispatch.

  • Grievant means an employee or group of employees having the same grievance. In the case of a group of employees, one employee shall be designated by the group to act as spokesperson and to be responsible for processing the grievance.

  • Interdisciplinary team means a group of persons with varied professional backgrounds who meet with the member to develop a comprehensive service plan to address the member’s need for services.

  • Apprenticeship program means a program registered with the U.S. Bureau of Apprenticeship and Training which contains the terms and conditions for the qualification, recruitment, selection, employment and training of apprentices, including the requirement for a written apprenticeship agreement.

  • Mobile crisis outreach team means a crisis intervention service for minors or families of minors experiencing behavioral health or psychiatric emergencies.

  • Diagnostic clinical procedures manual means a collection of written procedures that describes each method (and other instructions and precautions) by which the licensee performs diagnostic clinical procedures; where each diagnostic clinical procedure has been approved by the authorized user and includes the radiopharmaceutical, dosage, and route of administration.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Training program means a standardized medication

  • Maintenance Program means a maintenance program for the Aircraft approved by the Aviation Authority, in conformity with the Maintenance Planning Document.

  • Basic health plan model plan means a health plan as required in RCW 70.47.060(2)(e).