External Grievance Sample Clauses

External Grievance. The Contractor shall inform Enrollees that they may file an external Grievance through 1‑800 Medicare. The Contractor must display a link to the electronic Grievance form on the Xxxxxxxx.xxx Internet Web site on the Contractor’s main Web page as required by 42 C.F.R. § 422.504(b)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll‑free telephone number where an Enrollee Grievance may be filed. External Grievances filed with MassHealth shall be forwarded to the CMT and entered into the CMS Complaints tracking module, which will be accessible to the Contractor.
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External Grievance. The Contractor shall inform Enrollees that they may file an external Grievance through 1-800 Medicare. The Contractor must display a link to the electronic Grievance form on the Xxxxxxxx.xxx Internet Web site on the Contractor‘s main Web page as required by 42 C.F.R. § 422.504(b)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll-free telephone number where an Enrollee Grievance may be filed. External Grievances filed with MassHealth shall be forwarded to the CMT and entered into the CMS Enrollee Appeals Complaints tracking module, which will be accessible to the Contractor. All Contractors shall utilize and all Enrollees may access the existing Medicare Part D Appeals Process, as described in Appendix F. Consistent with existing rules, Part D Appeals will be automatically forwarded to the IRE if the Contractor misses the applicable adjudication timeframe. The Contractor must maintain written records of all Appeal activities, and notify CMS and MassHealth of all internal Appeals. Integrated/Unified Non-Part D Appeals Process Overview: 2.12.1.2.1. Notice of ActionIn accordance with 42 C.F.R. § 438.404 and 42 C.F.R. §§ 422.568-572, the Contractor must give the Enrollee written notice of any Adverse Benefit Determination. Such notice shall be provided at least ten (10) days in advance of the date of its action, in accordance with 42 C.F.R. § 438.404. An Enrollee or a provider acting on behalf of an Enrollee and with the Enrollee‘s written consent may Appeal the Contractor‘s decision to deny, terminate, suspend, or reduce services. In accordance with 42 C.F.R. § 438.402 and 42 C.F.R. § 422.574, an Enrollee or provider action on behalf of an Enrollee and with the Enrollee‘s consent may also Appeal the Contractor‘s delay in providing or arranging for a Covered Service. Appeal time frames - As more fully detailed below, Enrollees, and/or their providers, or their authorized Appeal representatives will have sixty (60) days to file an Appeal related to coverage and benefits. The Contractor shall acknowledge receipt of each Appeal and notify EOHHS of Board of Hearings Appeals daily. Appeal levels Initial Appeals (first level internal Appeal) will be filed with the Contractor. Subsequent Appeals for traditional Medicare A and B services will be automatically forwarded to the Medicare Independent Review Entity (IRE) by the Contractor. Subsequent Appeals for services covered by MassHealth only (e.g. Personal Assistance Service...
External Grievance. A Participant may file an external grievance through the process outlined in the Three-way Contract.
External Grievance. If Our decision under the Appeals process is not satisfactory to you, you may qualify to request an External Grievance. To qualify for an External Grievance all of the following requirements must be met:
External Grievance 

Related to External Grievance

  • Group Grievance Where a number of employees have identical grievances and each employee would be entitled to grieve separately they may present a group grievance in writing signed by each employee who is grieving to the Administrator or her designate within ten (10) days after the circumstances giving rise to the grievance have occurred or ought reasonably to have come to the attention of the employee(s). The grievance shall then be treated as being initiated at Step No. 1 and the applicable provisions of this Article shall then apply with respect to the processing of such grievance.

  • Policy Grievance – Union Grievance The Union may institute a grievance alleging a general misinterpretation or violation of this Agreement by the Employer by submitting a written grievance at Step No. 1 within twenty (20) days after the circumstances have occurred. This section shall not apply to disciplinary grievances or application of competitive clauses under this Agreement.

  • Grievance A grievance is an alleged violation, misinterpretation, or misapplication of the terms of the negotiated agreement between the Board and the Association.

  • Informal Grievance 1. Within fourteen (14) calendar days of the event giving rise to a grievance, the grievant shall present the grievance informally for disposition by the immediate supervisor or at any appropriate level of authority within the department. 2. Presentation of an informal grievance shall be a prerequisite to the institution of a formal grievance.

  • Policy Grievance Where either Party disputes the general application, interpretation or alleged violation of an article of this Agreement, the dispute shall be discussed initially with the Employer or the Union, as the case may be, within thirty (30) days of the occurrence. Where no satisfactory agreement is reached, either Party may submit the dispute to arbitration, as set out in Article 10.

  • Grievability Denial of a petition for reinstatement is grievable. The grievance may not be based on information other than that shared with the Employer at the time of the petition for reinstatement.

  • Employee Grievance If an employee considers there has been a significant change to the job content of the position held, the employee may initiate a grievance by using Step 1 of the Grievance Procedure. If the issue is not resolved at this step, the Job Classification Review Procedure of Article 22.02(B) above shall be utilized.

  • Formal Grievance Step 1 6

  • Statement of Grievance The grievance shall contain a statement of: (a) The specific situation, act or acts complained of as an agreement violation; (b) The inequity or damage suffered by the employee; and (c) The relief sought.

  • PROFESSIONAL GRIEVANCE PROCEDURE A. A claim by a teacher or the Association that there has been a violation, misinterpretation or misapplication of any provision of this Agreement or any rule, order or regulation of the Board may be processed as a grievance as hereinafter provided. B. The grievant may invoke the formal grievance procedure on the form set forth in annexed Schedule C, signed by the grievant and a representative of the Association, which form shall be available for the Association representative in each building. A copy of the grievance form shall be delivered to the principal or supervisor. If the grievance involves more than one school building, it may be filed with the superintendent or a representative designated by him. C. Within five (5) school days of receipt of the grievance, the principal or supervisor shall meet with the Association in an effort to resolve the grievance. The principal or supervisor shall indicate his disposition of the grievance in writing within five (5) school days of such meeting, and shall furnish a copy thereof to the Association. D. If the Association is not satisfied with the disposition of the grievance, or if no disposition has been made within five (5) school days of such meeting or ten (10) school days from the date of filing, whichever shall be later, the grievance shall be transmitted to the Superintendent. Within five (5) school days the superintendent or his designee shall meet with the Association on the grievance and indicate his disposition of the grievance in writing within five (5) school days of such meeting, and shall furnish a copy thereof to the Association. E. If the Association is not satisfied with the disposition of the grievance by the Superintendent or his designee, or if no disposition has been made within five (5) school days of such meeting or ten (10) school days from the date of filing, whichever shall be later, the grievance shall be submitted to the Board within ten (10) working days by filing a written copy thereof with the Secretary or other designee of the Board. The Board, no later than its next regular meeting or two (2) calendar weeks, whichever shall be later, shall hold a hearing on the grievance, and give such other consideration as it shall deem appropriate. Disposition of the grievance in writing by the Board shall be made no later than seven (7) days thereafter. A copy of such disposition shall be furnished to the Association. F. The Association may request arbitration of any unresolved grievance which is arbitrable by filing the Arbitration Request Form with the American Arbitration Association and delivering a copy of this Form to the Employer through the Superintendent's Office within thirty (30) working days following the receipt of the Board's written disposition. If the Board fails to answer a grievance within the time limits set forth in Paragraph E, the Association may request arbitration by filing the Arbitration Request Form with the American Arbitration Association and delivering a copy of this Form to the Employer through the Superintendent's Office not later than thirty (30) working days following the date the Board's written disposition was due. The grievance may thereafter be submitted to arbitration. If the Association does not request arbitration in the manner or within the time limits established herein, the grievance shall be considered settled on the basis of the Employer's last disposition. If a grievance is to be submitted to arbitration, the arbitrator shall be selected from a panel submitted by the American Arbitration Association pursuant to their rules The fees and expenses of the arbitrator and all hearing location costs shall be shared equally by the Association and the Employer. Each party shall pay the fees, expenses, wages, and any other compensation of its own representatives and legal counsel. The arbitrator's powers shall be limited to the application and interpretation of this Agreement as written. The arbitrator shall at all times be governed wholly by the terms of this Agreement and shall have no power or authority to amend, alter or modify this Agreement either directly or indirectly, or to rule upon a specific grievance considered settled. In addition, the following may not be considered by the arbitrator: 1. The termination of service of or failure to reemploy any probationary teacher. 2. Any action involving a tenured teacher, including but not limited to discharge, demotion, layoff or failure to recall, if that action when timely raised is subject to review before the Michigan Teacher Tenure Commission. If the issue of arbitrability is raised, the arbitrator shall not determine the merits of any grievance unless arbitrability has been affirmatively decided. The arbitrator's decision shall be final and binding upon the Association, the Employer and employees in the bargaining unit; provided, however, that each party may have its legal remedies if the arbitrator exceeds the jurisdiction provided in this Agreement. G. If any teacher for whom a grievance is sustained shall be found to have been unjustly discharged, he shall be reinstated with full reimbursement of all professional compensation lost. If he shall have been found to have been improperly deprived of any professional compensation or advantage, the same or its equivalent in money shall be paid to him. H. The time limits provided in this article shall be strictly observed but may be extended by written agreement of the parties. In the event a grievance is filed after May 15 of any year and strict adherence to the time limits may result in hardship to any party, the Board shall use its best efforts to process such grievance prior to the end of the school term or as soon thereafter as possible. I. If an individual teacher has a personal complaint which he desires to discuss with a supervisor, he is free to do so without recourse to the grievance procedure. However, no grievance shall be adjusted without prior notification to the Association and opportunity for an Association representative to be present, nor shall any adjustment of a grievance be inconsistent with the terms of the Agreement. In the administration of the grievance procedure, the interests of the teachers shall be the sole responsibility of the Association. J. Filing time for an alleged violation is limited to twenty (20) teaching days from the date of an alleged incident.

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