Common use of Appeals and Grievances Clause in Contracts

Appeals and Grievances. (a) Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints relating to the scope of Covered Services required to be provided under the QHP. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368.

Appeals and Grievances. (a) Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints relating to the scope of Covered Services required to be provided under the QHPSADP. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368, if applicable.

Appeals and Grievances. (a) Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints including, those relating to the scope of Covered Services required to be provided under the QHPQHP and/or relating to Medical Necessity. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 13681370.2.

Appeals and Grievances. (a) Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints relating to the scope of Covered Services required to be provided under the QHPSADP. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368.

Appeals and Grievances. (a) Internal. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and/or Provider, including appeals of claims and benefit determinations, and complaints relating to the scope of Covered Services required to be provided under the QHPQDP. Contractor’s processes shall comply with applicable laws, rules and regulations, including, those set forth at Health and Safety Code Section 1368.