Contractor's Notice of Adverse Determination. and Notice of a Right to Request a Fair Hearing shall include the following: i) the description of the action Contractor intends to take; ii) the reasons for the determination including the clinical rationale, if any; iii) the process for filing a grievance/complaint with the organization; iv) the timeframes within which a grievance/complaint must be made; v) the right of an Enrollee to designate a representative to file a grievance/complaint on behalf of the Enrollee; vi) the notice of the right of the Enrollee to contact the New York State Department of Health (800 206-8125) with their complaint; and vii) the notice entitled "Managed Care Action Taken" containing the Enrollee's fair hearing and aid continuing rights.
Appears in 7 contracts
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Contractor's Notice of Adverse Determination. and Notice of a Right to - Request a Fair Fair-Hearing shall include the following:
i) the description of the action Contractor intends to take;
ii) the reasons for the determination including the clinical rationale, if any;,
iii) the process for filing a grievance/complaint with the organization;
iv) the timeframes tuneframes within which a grievance/complaint must be made;
v) the right of an Enrollee to designate a representative to file a grievance/complaint on behalf of the Enrollee;
vi) the notice of the right of the Enrollee to contact the New York State Department of Health (800 206-8125) with their complaint; and
vii) the notice entitled "Managed Care Action Taken" containing the Enrollee's fair hearing and aid continuing rights.
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Amerigroup Corp)