Common use of ENROLLEE GRIEVANCES Clause in Contracts

ENROLLEE GRIEVANCES. a. The CONTRACTOR shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The CONTRACTOR shall have in place a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said process is accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. The LME/PIHP may receive complaints directly, which involve the CONTRACTOR. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR will be required to cooperate fully with all investigative requests as required by Controlling Authority. c. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR will be provided a written summary of the LME/PIHP’s findings. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR will maintain a system to receive and respond timely to complaints received regarding the CONTRACTOR. The CONTRACTOR will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.

ENROLLEE GRIEVANCES. a. The CONTRACTOR shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The In accordance with 10A NCAC 27G .0201(a)(18), the CONTRACTOR shall have in place a written policy for a Complaint and Grievance Process that is documented in written policy or procedures, and procedures for review and disposition of client grievances. The process shall ensure that said process is be accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. . The LME/PIHP may receive complaints directly, which involve the CONTRACTOR. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR will be required to cooperate fully with all investigative requests as required by Controlling Authority. c. . Failure to cooperate is a material breach of this contract. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR will be provided a written summary of the LME/PIHP’s findings. d. findings upon completion of the investigation. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required by the LME/PIHP to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR will maintain a system to receive and respond timely to complaints received regarding the CONTRACTOR. The CONTRACTOR will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.

ENROLLEE GRIEVANCES. a. The CONTRACTOR Contractor shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR Contractor shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The CONTRACTOR Contractor shall have in place a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said process is accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. The LME/PIHP may receive complaints directly, which involve the CONTRACTORContractor. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR Contractor will be required to cooperate fully with all investigative requests as required by Controlling Authority. c. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR Contractor will be provided a written summary of the LME/PIHP’s findings. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR Contractor may be required to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR Contractor will maintain a system to receive and respond timely to complaints received regarding the CONTRACTORContractor. The CONTRACTOR Contractor will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.

ENROLLEE GRIEVANCES. a. The CONTRACTOR shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The In accordance with 10A NCAC 27G .0201(a)(18), the CONTRACTOR shall have in place a written policy for a Complaint and Grievance Process that is documented in written policy or procedures, and procedures for review and disposition of client grievances. The process shall ensure that said process is be accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. The LME/PIHP may receive complaints directly, which involve the CONTRACTOR. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR will be required to cooperate fully with all investigative requests as required by Controlling Authority. Failure to cooperate is a material breach of this contract. c. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR will be provided a written summary of the LME/PIHP’s findingsfindings upon completion of the investigation. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required by the LME/PIHP to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR will maintain a system to receive and respond timely to complaints received regarding the CONTRACTOR. The CONTRACTOR will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.

ENROLLEE GRIEVANCES. a. The CONTRACTOR LIP shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR LIP shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The CONTRACTOR In accordance with 10A NCAC 27G .0201(a)(18), the LIP shall have in place a written policy for a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said a procedure for review and disposition of client grievances. The process is must be accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. The LME/PIHP may receive complaints directly, which involve the CONTRACTORLIP. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR LIP will be required to cooperate fully with all investigative requests as required by Controlling Authority. Failure to cooperate is a material breach of this contract. c. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR LIP will be provided a written summary of the LME/PIHP’s findingsfindings upon completion of the investigation. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR LIP will maintain a system to receive and respond timely to complaints received regarding the CONTRACTORLIP. The CONTRACTOR LIP will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.

ENROLLEE GRIEVANCES. a. The CONTRACTOR LIP shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR LIP shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The CONTRACTOR In accordance with 10A NCAC 27G .0201(a)(18), the LIP shall have in place a written policy for a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said a procedure for review and disposition of client grievances. The process is must be accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. . The LME/PIHP may receive complaints directly, which involve the CONTRACTORLIP. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR LIP will be required to cooperate fully with all investigative requests as required by Controlling Authority. c. . Failure to cooperate is a material breach of this contract. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR LIP will be provided a written summary of the LME/PIHP’s findings. d. During an findings upon completion of the investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR LIP will maintain a system to receive and respond timely to complaints received regarding the CONTRACTORLIP. The CONTRACTOR LIP will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.