Common use of Contractor's Notice of Adverse Determination Clause in Contracts

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.)

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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)

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