Common use of Document Maintenance, Appeals Clause in Contracts

Document Maintenance, Appeals. (A) The Contractor shall maintain all documentation relating to Appeals which includes, but is not limited to the following: (1) written Notices of Action; (2) a log of all oral Appeals and oral requests for expedited resolution of Appeals including: (i) date of the oral requests; (ii) date of acknowledgement of oral requests for expedited resolution of Appeals and method of acknowledgment (orally or in writing); (iii) date of denials of requests for expedited Appeals resolution; and (3) copies of written standard Appeal requests; (4) copies of written notices of denial of requests for expedited Appeal resolution; (5) date of acknowledgement of written standard Appeal requests and method of acknowledgment (orally or in writing); (6) copies of written notices when extending the time frame for adjudicating standard or expedited Appeals when the Contractor initiates the extension; (7) copies of written Notice of Appeal Resolution; and (8) any other pertinent documentation needed to maintain a complete record of all Appeals and to demonstrate that the Appeals were adjudicated according to the Contract provision governing Appeals.

Document Maintenance, Appeals. (A) The Contractor shall accurately, and in a manner accessible to the Department and available upon request to CMS, maintain all documentation relating to Appeals which includes, but is not limited to the followingto: (1) written Notices of ActionAdverse Benefit Determination; (2) date the Appeal request was received; (3) name of the Enrollee for whom the Appeal request was filed; (4) a log of all oral Appeals Appeal requests, and oral requests for expedited resolution of Appeals including: (i) date of the oral requests; (ii) date of acknowledgement of oral requests for expedited resolution of Appeals and method of acknowledgment (orally or in writing);; and (iii) date of denials of requests for expedited Appeals resolutionAppeals; and (35) copies of written standard Appeal requests; (46) copies of written notices of denial of requests for expedited Appeal resolutionAppeals; (57) date of acknowledgement of written standard Appeal requests and method of acknowledgment (orally or in writing); (6) 8) copies of written notices when extending the time frame timeframe for adjudicating completing standard or expedited Appeals when the Contractor initiates the extension; (79) date of each review, or if applicable, review meeting; (10) the resolution, and date of resolution at each level of review, or if applicable, review meeting; (11) name of person conducting the Appeal; (12) copies of written Notice of Appeal Resolution; and (8) 13) any other pertinent documentation needed to maintain a complete record of all Appeals and to demonstrate that the Appeals were adjudicated conducted according to the Contract provision provisions governing Appeals.

Document Maintenance, Appeals. (A) The Contractor shall accurately, and in a manner accessible to the Department and available upon request to CMS, maintain all documentation relating to Appeals Appeals, which includes, but is not limited to the following: (1) written Notices a general description of Actionthe reason for the Appeal; (2) the name of the Enrollee for whom the Appeal was filed; (3) written Notices of Adverse Benefit Determination (4) a log of all oral Appeals and oral requests for expedited resolution of Appeals including: (i) date of the oral requests; (ii) date of acknowledgement of oral requests for expedited resolution of Appeals and method of acknowledgment (orally or in writing); (iii) date of denials of requests for expedited Appeals resolution; and (35) copies of written standard Appeal requests; (46) copies of written notices of denial of requests for expedited Appeal resolution; (57) date of acknowledgement of written standard Appeal requests and method of acknowledgment (orally or in writing); (6) 8) copies of written notices when extending the time frame for adjudicating standard or expedited Appeals when the Contractor initiates the extension; (79) date of each review, or if applicable, review meeting; (10) resolution and date of resolution at each level, if applicable; (11) copies of written Notice of Appeal Resolution; and (8) 12) any other pertinent documentation needed to maintain a complete record of all Appeals and to demonstrate that the Appeals were adjudicated conducted according to the Contract provision governing Appeals.