DISPUTE RESOLUTION----The Clause Samples

DISPUTE RESOLUTION----The. Department shall be the sole arbitrator of disputes concerning the criteria described in 11 a - d of this addendum and all other requirements of this addendum and of disputes arising out of MOUs negotiated. A local board, county social or human service department, recipient, or advocate for an enrollee, may request a review of complaints regarding denial of access to medically necessary Medicaid-covered services after they have utilized the HMO dispute resolution process. The Department shall review the complaint and make a final determination. The Department will accept written comments from all parties to the dispute prior to making a decision. Failure to pay providers promptly within 30 days for properly referred care will be considered as a denial of access to such care. Where a Departmental ruling is invoked in any dispute relating to the terms of this addendum, the Department's decision shall be communicated to the HMO Contract for January 1, 2002 - December 31, 2003 -123- HMO, and when appropriate, to the 51.42, 51.437, or 46.23 Board and/or to the county social service or human service department, in writing and within 30 days of receipt of the request. The HMO shall abide by all decisions of the Department.