Enrollee Appeals and Grievances Sample Clauses

Enrollee Appeals and Grievances. Internal Grievances and Appeals. Contractor shall maintain an internal review process to resolve Enrollee’s written or oral expression of dissatisfaction regarding the Contractor and Participating Providers, including appeals of claim and benefit determinations, and complaints relating to the scope of Covered Services required to be covered under the QDP. Contractor’s processes shall comply with State and Federal laws, rules and regulations relating to enrollee rights and appeals processes, specifically including grievance requirements, set forth at Health and Safety Code § 1368 regardless of the State Regulator for the Contractor’s QDPs.
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Enrollee Appeals and Grievances 
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Related to Enrollee Appeals and Grievances

  • COMPLAINTS AND GRIEVANCES 22.01 It is the mutual desire of the parties to this Agreement that reasonable and legitimate complaints and grievances of employees shall be dealt with as quickly as possible.

  • Policy Grievances ‌ Where either party to this agreement disputes the general application, interpretation or alleged violation of an article of this agreement, the dispute shall be discussed initially with the Executive Director or designate or the President of the Union within 14 calendar days of the occurrence. Where no satisfactory agreement is reached, either party, within a further 14 calendar days, may submit the dispute to arbitration.

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