Provider Complaint definition

Provider Complaint. A written expression by a Provider, which indicates dissatisfaction or dispute with the Contractor’s policies, procedures, or any aspect of a Contractor’s administrative functions, including a Proposed Action.
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Provider Complaint means a provider’s complaint about the contractor’s performance. Verified provider complaints are used as a measure of the quality of the contractor’s performance under this SOW.
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Examples of Provider Complaint in a sentence

  • The Manage Provider Complaint, Grievance and Appeal business process handles provider appeals of adverse decisions or communications of a complaint or grievance.

  • The Managed Care Plan must complete the Provider Complaint Report as specified on the instructions tab of the report template using the appropriate template provided on the Agency website.

  • This report will detail the nature of the complaint, timeline of the complaint, as well as the resolution.FREQUENCY & DUE DATES: This report is due monthly, within fifteen (15) calendar days after the end of the reporting month.SUBMISSION: Using the file naming convention described in Chapter 2, the Managed Care Plan must submit the following to the SMMC SFTP site: ⮚ The completed Provider Complaint Report template, which must be submitted as an XLS file.

  • Providers who believe they are subject to such behavior by any agent of the State should first attempt resolution through the AFH Provider Complaint Resolution Process.

  • Disputes With Your Provider Complaint Resolution: Please contact your REP if you have specific comments, questions or complaints.

  • The Managed Care Plan must complete the Provider Complaint Report using the appropriate report template provided on the Agency website.

  • This report will detail the nature of the complaint, timeline of the complaint, as well as the resolution.FREQUENCY & DUE DATES: This report is due monthly, within fifteen (15) calendar days after the end of the reporting month.SUBMISSION: Using the file naming convention described in Chapter 2, the Managed Care Plan must submit the following to the SMMC SFTP site:  The completed Provider Complaint Report template, which must be submitted as an XLS file.

  • A Provider may file a complaint in writing regarding dissatisfaction with WellCare’s policies, procedures, or any other communication or action taken by WellCare, by mailing or faxing a Provider Complaint Form with supporting documentation, to WellCare’s Grievance Department.

  • The Managed Care Plan shall submit the report using the Provider Complaint Log template in accordance with the Report Guide.

  • This response should detail:• Name of driver or other staff beneficiary involved• Detailed description of the occurrence• Any documentation to support the provider’s claim• A corrective action plan detailing changes that will be made to ensure future similar issues do not occur Beneficiary and Medical Provider Complaint Resolution ProcessEach Complaint shall be assigned a unique tracking number.

Related to Provider Complaint

  • Product Complaint means any written, verbal or electronic expression of dissatisfaction regarding the Product, including without limitation reports of actual or suspected product tampering, contamination, mislabeling or inclusion of improper ingredients.

  • Service Complaints For service problems or complaints, you should contact your local utility by calling: AEP Ohio at 000.000.0000. IN THE EVENT OF AN ENERGY-RELATED EMERGENCY, SUCH AS A POWER OUTAGE OR DOWNED POWER LINE, PLEASE VACATE THE AREA BY A SAFE DISTANCE AND CALL YOUR LOCAL UTILITY or 911. Authorization/Representation/Letter of Agency:By entering into this Agreement, you authorize XOOM to act on your behalf under your local utility’s tariffs in accordance with the rules and regulations of the PUCO. You acknowledge that you are your local utility account holder, or a person legally authorized to execute this Agreement on behalf of the account holder for electricity service and are at least eighteen (18) years of age. You agree to authorize XOOM to obtain your credit information and you agree to authorize your local utility to release all information relating to your historical and current electricity usage, billing and payment history to XOOM or its authorized representatives. You acknowledge that XOOM has full authority to make all rates and tariff selections necessary to meet its obligations under this Agreement. You may rescind this authorization at any time by contacting XOOM. Neither your social security number, customer account number nor any other customer financial information will be released by XOOM, except where such release is required by court order or by Commission Order or Rule, without your affirmative written consent. Execution of this Agreement shall constitute authorization for the release of this information to XOOM.

  • Complaints means each of the following documents:

  • Provider Service means a Provider’s hosted online services (if any) as described in the Solution Exhibit which is provided by Provider to Customers located in the Territory through remote access via the Internet as part of the BPO Service. A Provider Platform Application shall be considered a Provider Service.

  • Provider is any individual or company that provides professional or technical services.

  • Complaint means any formal written complaint raised by a Contracting Body in relation to the performance of this Framework Agreement or any Call-Off Contract in accordance with Clause 44 (Complaints Handling and Resolution);

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Formal complaint means a document filed by a complainant or signed by the Title IX Coordinator alleging sexual harassment against a respondent and requesting an investigation of the allegation of sexual harassment.

  • Complaint Investigation means an investigation of any complaint that has been made to a proper authority that is not covered by an abuse investigation.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide items and services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • ProviderOne or “P1” means the system commonly referred to as the Medicaid Management Information System (MMIS), and is the federally approved system used by the Washington Medicaid program to pay provider claims for goods and services authorized under the State Plan. The MMIS is certified by CMS and is the primary information system used by HCA to pay for health care.

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Environmental Complaint shall have the meaning set forth in Section 4.19(d) hereof.

  • Provider fee means the consideration paid for a service contract.

  • 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.

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

  • HMO means any health maintenance organization, managed care organization, any Person doing business as a health maintenance organization or managed care organization, or any Person required to qualify or be licensed as a health maintenance organization or managed care organization under applicable federal or state law (including, without limitation, HMO Regulations).

  • Enrollee means any person entitled to health care services from a carrier.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Contractor Related Parties means any affliates of the Contractor and the Contractor's executive officers, Pennsylvania officers and directors, or owners of 5 percent or more interest in the Contractor.

  • Enhanced 911 Service (“E911”) means a telephone communication service which will automatically route a call dialed “9-1-1” to a designated public safety answering point (PSAP) attendant and will provide to the attendant the calling party’s telephone number and, when possible, the address from which the call is being placed and the Emergency Response agencies responsible for the location from which the call was dialed.

  • Provider Organization means a group practice, facility, or organization that is: