Agreements with Providers and Subcontractors. (A) The Contractor shall inform Providers and Subcontractors at the time they enter into a Network Provider agreement or a Subcontract about: (1) the Grievance, Appeal, and State Fair Hearing procedures and timeframes as specified in 42 CFR § 438.400 through 42 CFR § 438.424; (2) the Enrollee’s right to file Grievances and request Appeals and the requirements and timeframes for filing; (3) the availability of assistance to the Enrollee with filing Grievances and requesting Appeals; (4) the Enrollee’s right to request a State Fair Hearing after the Contractor has made a determination on the Appeal if it is adverse to the Enrollee; and (5) if the Contractor makes an Adverse Benefit Determination to reduce, suspend or terminate services:
Appears in 12 contracts
Samples: Utah Medicaid Contract, Utah Medicaid Contract, Utah Medicaid Contract
