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 General 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 Action – In 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...
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External Grievance. A Participant may file an external grievance through the process outlined in the Three-way Contract.
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External Grievance. The Contractor shall inform Enrollees that they may file an external grievance for Medicare only covered benefits and services through 1-800-Medicare or for Medicare and Medi-Cal covered benefits and services through the Cal MediConnect Ombudsman program. 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 per 42 C.F.R. § 422.504(a)(15)(ii).
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External Grievance 
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Related to External Grievance

  • External Appeals For appeals of a decision that a prescription drug is not covered because it is not on our formulary, please see the Formulary Exception Process in the Prescription Drug and Diabetic Equipment and Supplies section. When filing a reconsideration or an appeal, please provide the same information listed in the Complaints section above.

  • Company Grievance It is understood that the Company may request a meeting with the Union for the purpose of presenting any complaints with respect to the conduct of the Union. If such a complaint by the Company is not settled, it may be submitted in writing as a grievance at Step 3 and may be referred to arbitration.

  • 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.

  • External monitoring The external monitoring and audit referred to in Articles 11.1, 11.2, 11.3 and 11.4 of the Regulation shall not in any way relieve the National Focal Point or the Programme Operator of their obligations under the legal framework regarding monitoring of the Programme and/or its projects, financial control and audit.

  • 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.

  • Year-End Grievance In the event a grievance is filed at such time that it cannot be processed through all steps in this grievance procedure by the end of the school year and, if left unresolved until the beginning of the following school year, could result in irreparable harm to a party in interest, the time limits set forth herein shall be reduced so that the grievance procedure may be exhausted prior to the end of the school year or within a maximum of 30 days thereafter. Reduction of the time limit shall be with mutual consent.

  • Informal Grievance The aggrieved employee or group of employees or a representative of the Union shall orally present the grievance to the employee's Supervisor or his/her designated representative within five (5) standard working days following the occurrence of events on which the grievance is based. The Supervisor shall give his/her answer within five (5) standard working days of the date of presentation of the grievance. Grievance settlements at the informal level shall set no precedents in any future MOU interpretation.

  • 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.

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