Urgent grievance definition

Urgent grievance means a grievance where using the standard timeframe of the grievance process would: (a) seriously jeopardize the life or health of a member; or (b) would jeopardize the member’s ability to regain maximum function.
Sample 1Sample 2Sample 3
Urgent grievance a request for a Health Service that, if subject to the time limits applicable to Post-service Grievances or Pre-Service Grievances would do either of the following.
Sample 1Sample 2Sample 3
Urgent grievance means an adverse determination when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of a subscriber or would jeopardize the subscriber’s ability to regain maximum function.
Sample 1

Examples of Urgent grievance in a sentence

  • If You are not satisfied with a decision We made either before or after You have filed a Grievance and Your situation meets the requirements of an Urgent Grievance, You have the right to use this Urgent Care procedure.

  • For Urgent Grievance Appeals, a health care practitioner with knowledge of Your condition may act as Your representative.

  • We will decide Your Urgent Grievance as soon as possible, but no later than 72 hours after the receipt of the initial request for the Urgent Grievance.

  • We will treat Your Urgent Grievance pursuant to the procedure described in Section 8.2 and Section 8.4, except that We will shorten the time limits as follows.

  • We will acknowledge Your Urgent Grievance within 24 hours (and include any request for additional information, if appropriate).

  • Once identified as such, an Urgent Grievance will be subject to only one review before becoming eligible for the External Appeal process described in Section 8.6. Your Urgent Grievance may be expressed to Us orally or in writing and should set forth all issues, comments, or other documented evidence that support it.


More Definitions of Urgent grievance

Urgent grievance means an adverse determination when the standard time frame of the grievance procedure would seriously jeopardize the dental health of a member or would jeopardize the member’s ability to regain maximum function. Vendor – an individual or entity that engages in the business of selling care, goods, services, or commodities. Violation - each determination by the Agency that a PDHP failed to act as specified in the contract or in applicable statutes or rules governing Medicaid PDHPs. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required dental services or items to beneficiaries is considered for purposes of this contract to be a separate violation. 110.0 EXHIBITS‌ 110.1 FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES‌ Section 381.026, F.S.
Sample 1
Urgent grievance an adverse determination when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of an enrollee, or the enrollee's ability to regain maximum function. Violation - each determination by the department and/or agency that a contractor failed to act as specified in the contract or in applicable statutes or rules governing Medicaid prepaid health plans. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required services or items to enrollees is considered for purposes of this contract to be a separate violation. Attachment I- 7 of 55 Contract No. 0000-0000-00 LONG-TERM CARE COMMUNITY DIVERSION PILOT PROJECT REQUIREMENTS SECTION GENERAL CONTRACT REQUIREMENTS CONTRACTOR QUALIFICATIONS To qualify as a long-term care community diversion program contractor, the contractor must: A. Have a certificate of authority from the Florida Department of Insurance to operate as a health maintenance organization (HMO) pursuant to Chapter 641 Part I, Florida Statutes, and have a health care provider certificate from the Agency for Health Care Administration (agency) pursuant to Chapter 641.49, Florida Statutes, for those counties in the service area in which the applicant will apply to provide services or; B. Have a license issued pursuant to Chapter 400, Florida Statutes, and meet the provisions of an "other qualified provider" set forth in Section 430.703(7), Florida Statutes, including satisfying all financial and quality assurance requirements for a provider service network as specified in Section 409.912, Florida Statutes, and; C. Have, or have a subcontractor that has, prior experience in providing home and community-based long-term care services in the project service area and; D. Have the capacity to integrate the delivery of acute and long-term care services to enrollees; and E. Meet all the requirements to enroll as a Medicaid prepaid health services provider; and F. Meet all other requirements in the remaining provisions of this contract and its attachments.
Sample 1
Urgent grievance. A written complaint from a member expressing dissatisfaction with: o Any request to reconsider as adverse initial determination (denial of service) o Written appeal to a previous determination of a urgent complaint that, if left unresponded to, has the potential to become an emergency. All grievances triaged as "urgent" will be fully responded to within 48 hours of APSH PR notification of the complaint. PROCEDURE:
Sample 1

Related to Urgent grievance

  • 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.

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

  • 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.

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

  • 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.

  • Grievance System means the overall system that includes:

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

  • Urgent means the onset of symptoms requiring attention within 48 hours to prevent a serious deterioration in an individual's mental or physical health or threat to safety.

  • Labor dispute as used here, means a strike, lockout, or other labor dispute between the Employer and its Employees, during which time the Employee is not paid by the Employer.

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

  • Attack directed against any civilian population means a course of conduct involving the multiple commission of acts referred to in paragraph 1 against any civilian population, pursuant to or in furtherance of a State or organizational policy to commit such attack;

  • 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.

  • Problem means an unknown underlying cause of one or more Incidents. It becomes a Known Error when the root cause is known and a temporary workaround or permanent alternative has been identified.

  • 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.

  • Plagiarism means to take and present as one's own a material portion of the ideas or words of another or to present as one's own an idea or work derived from an existing source without full and proper credit to the source of the ideas, words, or works. Plagiarism includes, but is not limited to:

  • 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);

  • Complaints Procedure means the School's procedure for handling complaints from parents, as amended from time to time for legal or other substantive reasons, or in order to assist the proper administration of the School. It does not form part of the contract between you and the School. A copy of the most up-to-date procedure is on the School's website and is otherwise available from the School at any time upon request;

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

  • Complaints means each of the following documents:

  • Violent juvenile felony means any of the delinquent acts enumerated in subsection B or C of

  • legal or administrative action means any legal proceeding or arbitration and any administrative or regulatory action or investigation;

  • Behavioral health disorder means either a mental disorder

  • Urgent Work means any urgent measures which in the opinion of Engineer-in-charge become necessary during the progress of the work to obviate any risk of accident or failure or disruption of generation which become necessary for security.

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Urgent medical condition means a condition that satisfies either of the following:

  • Functional behavioral assessment means an individualized assessment of the student that results in a team hypothesis about the function of a student’s behavior and, as appropriate, recommendations for a behavior intervention plan.