Appeals and Grievances. MA-PD Sponsor agrees to comply with all requirements in Subpart M of 42 CFR Part 423 governing coverage determinations, grievances and appeals, and formulary exceptions. MA-PD Sponsor acknowledges that these requirements are separate and distinct from the appeals and grievances requirements applicable to the MA-PD Sponsor through the operation of its Part C or cost plan benefits.
Appears in 15 contracts
Samples: Medicare Managed Care Contract Addendum (Amerigroup Corp), Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.), Contract With Eligible Medicare Advantage Organization (Molina Healthcare Inc)
Appeals and Grievances. MA-PD Sponsor agrees to comply with all requirements in Subpart M of 42 CFR Part 423 governing coverage determinations, grievances and appeals, and formulary exceptions. MA-MA- PD Sponsor acknowledges that these requirements are separate and distinct from the appeals and grievances requirements applicable to the MA-PD Sponsor through the operation of its Part C or cost plan benefits.
Appears in 4 contracts
Samples: Contract With Eligible Medicare Advantage Organization (HealthSpring, Inc.), Contract With Eligible Medicare Advantage Organization (HealthSpring, Inc.), Contract With Eligible Medicare Advantage Organization (HealthSpring, Inc.)
Appeals and Grievances. MA-PD Sponsor agrees to comply with all requirements in Subpart M of 42 CFR Part 423 governing coverage determinations, grievances and appeals, and formulary exceptionsexceptions and the relevant provisions of Subpart U governing reopenings. MA-PD Sponsor acknowledges that these requirements are separate and distinct from the appeals and grievances requirements applicable to the MA-PD Sponsor through the operation of its Part C or cost plan benefits.
Appears in 4 contracts
Samples: Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.), Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.), Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.)
