DPW Fair Hearing Process for Members. During all phases of the PH-MCO Grievance process, and in some instances involving Complaints, the Member has the right to request a Fair Hearing with the Department. The PH-MCO must comply with the DPW Fair Hearing Process requirements defined in Exhibit GG of this Agreement, Complaint, Grievance and DPW Fair Hearing Processes. A request for a DPW Fair Hearing does not prevent a Member from also utilizing the PH-MCO’s Complaint or Grievance process. If a member requests both an external appeal/review and a DPW Fair Hearing, and if the decisions rendered are in conflict with one another, the PH-MCO must abide by the decision most favorable to the member. In the event of a dispute or uncertainty regarding which decision is most favorable to the member, the PH-MCO will submit the matter to DPW’s Grievance and Appeals Coordinator for review and resolution.
Appears in 4 contracts
Samples: Grant Agreement, Grant Agreement, Healthchoices Agreement
DPW Fair Hearing Process for Members. During all phases of the PH-MCO Grievance process, and in some instances involving Complaints, the Member has the right to request a Fair Hearing with the Department. The PH-MCO must comply with the DPW Fair Hearing Process requirements defined in Exhibit GG of this Agreement, Complaint, Grievance and DPW Fair Hearing Processes. A request for a DPW Fair Hearing does not prevent a Member from also utilizing the PH-MCO’s Complaint or Grievance process. If a member requests both an external appeal/review and a DPW Fair Hearing, and if the decisions rendered are in conflict with one another, the PH-MCO must abide by the decision most favorable to the member. In the event of a dispute or uncertainty regarding which decision is most favorable to the member, the PH-MCO will submit the matter to DPW’s Grievance and Appeals Coordinator for review and resolution.
Appears in 2 contracts
