Common use of COMPLAINTS/ APPEALS Clause in Contracts

COMPLAINTS/ APPEALS. Provider appeals are governed by the Virginia Administrative Process Act (Virginia Code § 2.2-4000 et seq.) and the Department’s provider appeals regulations 12 VAC 00-00-000 through 12 VAC 00-00-000. Provider has the right to appeal adverse decisions to the Department. However, United’s internal appeal process must be exhausted prior to a Provider filing an appeal with the DMAS Appeals Division. United shall assist DMAS by presenting the Department’s position in the administrative appeals process in conjunction with appeals of Contractor actions filed by providers.

COMPLAINTS/ APPEALS. Provider appeals are governed by the Virginia Administrative Process Act (Virginia Code § 2.2-4000 et seq.) and the Department’s provider appeals regulations 12 VAC 00-00-000 through 12 VAC 00-00-000. Provider has the right to appeal adverse decisions to the Department. However, UnitedSubcontractor’s and/or Health Plan’s internal appeal process must be exhausted prior to a Provider filing an appeal with the DMAS Appeals Division. United Subcontractor and/or Health Plan shall assist DMAS by presenting the Department’s position in the administrative appeals process in conjunction with appeals of Contractor actions filed by providers.