Complaints, Grievances and Appeals. Leave of absence with pay may be granted by the Employing Authority to officers and members of the Union in the following circumstances:
Complaints, Grievances and Appeals. This Se tion explains how to file a Complaint, Grievance and Appeal. When we use the words "we", "us", and "our" in this document, we are referring to Presbyterian Health Plan as the Health Care Insurer. When we use the words “you” and “your” we are referring to each You (Member) and/or your representative. Overview Many Complaints or problems can be handled informally by calling Presbyterian Health Plan 1 a
Complaints, Grievances and Appeals. 90 This Section explains how to file a Complaint, Grievance and Appeal. Overview 90 Computation of Time 90 General Requirements and Information Regarding Grievance Procedures 90 Information About Grievance Procedures 91 Confidentiality of Your Records and Medical Information 92 Preliminary Determination 92 Timeframes for Initial Determinations 93 Initial Determinations 93 Notice of Initial Determinations 94 Rights Regarding Internal Review of Adverse Determinations 95 Timeframes for Internal Review of Adverse Determinations 96 Internal Panel Review of Adverse Determinations 97 Additional Requirements for Expedited Internal Review of Adverse Determinations 98 Notice of Internal Panel Decision 99 External Review of Adverse Determinations 99 Filing Requirements for External Review of Adverse Determinations 101 Acknowledgement of Request for External Review of Adverse Determination and Copy to Health Care Insurer 102 Timeframes for External Review and Adverse Determinations 102 Criteria for Initial External Review of Adverse Determination by the Office of Superintendent of Insurance Staff 103 Additional Criteria for Initial External Review of Experimental or Investigational Treatment Adverse Determinations by the Office of Superintendent of Insurance 103 Initial External Review of Adverse Determination by the Office of Superintendent of Insurance Staff 104 Hearing Procedures for External Review of Adverse Determinations 105 Independent Co-Health Officers (ICOs) 106 Superintendent’s Decision on External Review of Adverse Determination 107 Internal Review of Administrative Grievances 107 Initial Internal Review Decision on Administrative Grievance 108 Reconsideration of Internal Review 108 Decision of Reconsideration Committee 109 External Review of Administrative Grievances 110 Filing Requirements for External Review of Administrative Grievance 111 Acknowledgement of Request for External Review of Administrative Grievance and Copy to Health Care Insurer 111 Review of Administrative Grievance by Superintendent 112 Records 113 Your medical records are important documents needed in order to administer your Health Benefits Plan. This Section explains how we ensure the confidentiality of these records and how these records are used to administer your plan. Creation of Non-Medical Records 113 Accuracy of Information 113 Consent for Use and Disclosure of Medical Records 113 Professional Review. 113 Confidentiality of Protected Health Information/Medical Records 113 El...
Complaints, Grievances and Appeals. Information on how Provider or Provider’s authorized representative can submit complaints and file grievances and appeals, and the resolution process, is contained in the applicable provider manual.
Complaints, Grievances and Appeals. 4.9.1 To the extent not covered below, the PASSE’s grievance and appeal system must comply with the requirements set forth in §160.000 and §190.000 of the Medicaid Provider Manual, and with all applicable federal and state laws, rules, and regulations, including 42 CFR Part 431, Subpart E (Fair Hearings for Applicants and Beneficiaries) and 42 CFR Part 438, Subpart F (Grievance and Appeal System), the Medicaid Fairness Act, and the Arkansas Administrative Procedures Act (Ark. Code Xxx. § 00-00-000 et seq.).
Complaints, Grievances and Appeals. Information on how Provider or Provider’s authorized representative shall submit complaints and file grievances and appeals, and the resolution process, is contained in the Subcontractor or CCO MississippiCHIP Provider Manual.
Complaints, Grievances and Appeals. The Provider shall develop, implement and maintain a system for tracking and resolving Beneficiary complaints and appeals regarding its services, processes, procedures, and staff. The Provider shall respond fully and completely to each complaint and establish a tracking mechanism to document the status and finally disposition of each appeal. Beneficiary complaints and appeals shall be subject to disposition consis tent with applicable insurance law or regulations. The Provider shall resolve at a minimum ninety-eight percent (98%) of Beneficiary complaints and appeals shall be resolved within thirty calendar (30) days.
Complaints, Grievances and Appeals. This Se tion explains how to file a Complaint, Grievance and Appeal. When we use the words "we", "us", and "our" in this document, we are referring to Presbyterian Health Plan as the Health Care Insurer. When we use the words “you” and “your” we are referring to each You (Member) and/or your representative. Overview PCSC Call 505‐923‐ 6980 Many Complaints or problems can be handled informally by calling Presbyterian Health Plan (PHP) Monday through Friday from 7:00 a.m. to 6:00 p.m. at (000) 000-0000 or toll-free at 1- 800-3656-2219 Hearing impaired users may call our TTY line at 711 or toll-free 1-800-659- 8331 or visit our website at xxx.xxx.xxx. The Managed Health Care Bureau of the Office of Superintendent of Insurance is also available to assist you with Grievances, questions or Complaints; call 1-888-4ASK-OSI (0-000-000-0000). Computation of Time Whenever the following requirements and procedures, in accordance with State Law, requires that an action be taken within a certain period of time from receipt of a request or document, the request or document shall be deemed to have been received within three (3) working days of the date it was mailed.
Complaints, Grievances and Appeals. This Se xxxx explains how to file a Complaint, Grievance and Appeal. When we use the words "we", "us", and "our" in this document, we are referring to Presbyterian Insurance Company, Inc. as the Health Care Insurer. When we use the words “you” and “your” we are referring to each You (Member) and/or your representative. Overview Many Complaints or problems can be handled informally by calling Presbyterian Insurance CSC Call P 505‐923‐6980 1‐800‐923‐6980 Company, Inc. (PIC) Monday through Friday from 7:00 a.m. to 6:00 p.m. at (000) 000-0000 or oll-free at 0-000-000-0000. Hearing impaired users may call our TTY line at 711 or toll-free t 0-000-000-0000 or visit our website at xxx.xxx.xxx. The Managed Health Care Bureau of he Office of the Superintendent of Insurance (OSI) is also available to assist you with t a t Grievances, questions or Complaints; call 1-855-4ASK-OSI (0-000-000-0000). Computation of Time Whenever the following requirements and procedures, in accordance with State Law, requires that an action be taken within a certain period of time from receipt of a request or document, the request or document shall be deemed to have been received within three (3) working days of the date it was mailed.
Complaints, Grievances and Appeals
