Common use of Division Review of Contractor Grievance Decisions Clause in Contracts

Division Review of Contractor Grievance Decisions. A final grievance decision by the Plan may be appealed by the Enrollee to the Division. The Division's appointed Hearing Officer will review the grievance record, gather additional information if necessary, and provide the Enrollee and his or her representative or the representative of a deceased Enrollee’s estate and the Plan an opportunity to be heard. The Hearing Officer will recommend a resolution of the grievance to the Executive Director of the Division. The Executive Director will render a final decision. The Division review of Plan grievances decisions will not exceed 90 days minus the number of days taken by the Plan to resolve the appeal internally. The decision by the Division shall be final, subject to appropriate judicial review. For appeals that meet the criteria for expedited resolution, as expeditiously as the Enrollee’s health condition requires, but no later than 72 hours after receipt of the request for appeal from the Enrollee or receipt of the file from the Contractor the Division will take final administrative action.

Division Review of Contractor Grievance Decisions. A final grievance decision by the Plan may be appealed by the Enrollee to the Division. The Division's appointed Hearing Officer will review the grievance record, gather additional information if necessary, and provide the Enrollee and his or her representative or the representative of a deceased EnrolleeXxxxxxxx’s estate and the Plan an opportunity to be heard. The Hearing Officer will recommend a resolution of the grievance to the Executive Director of the Division. The Executive Director will render a final decision. The Division review of Plan grievances decisions will not exceed 90 days minus the number of days taken by the Plan to resolve the appeal internally. The decision by the Division shall be final, subject to appropriate judicial review. For appeals that meet the criteria for expedited resolution, as expeditiously as the Enrollee’s health condition requires, but no later than 72 hours after receipt of the request for appeal from the Enrollee or receipt of the file from the Contractor the Division will take final administrative action.