Common use of Filing Grievances and Appeals Clause in Contracts

Filing Grievances and Appeals. 1. A grievance may be filed orally or in writing within one (1) year of the occurrence. 2. An appeal may be filed orally or in writing within thirty (30) calendar days of the enrollee’s receipt of the notice of action and, except when expedited resolution is required, must be followed with a written notice within ten (10) calendar days of the oral filing. The date of oral notice shall constitute the date of receipt. 3. The Health Plan shall provide any reasonable help to the enrollee in completing forms and following the procedures for filing a grievance or appeal or requesting a Medicaid Fair Hearing. This includes interpreter services, toll-free calling, and TTY/TTD capability. 4. The Health Plan shall handle grievances and appeals as follows: a. Provide the enrollee a reasonable opportunity to present evidence and allegations of fact or law in person as well as in writing. b. Ensure the enrollee understands any time limits that may apply. c. Provide opportunity before and during the process for the enrollee or an authorized representative to examine the case file, including medical records, and any other material to be considered during the process. d. Consider as parties to the appeal the enrollee or an authorized representative or, if the enrollee is deceased, the legal representative of the estate. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract

Filing Grievances and Appeals. 1. A grievance may be filed orally or in writing within one (1) year of the occurrence. 2. An appeal may be filed orally or in writing within thirty (30) calendar days of the enrollee’s receipt of the notice of action and, except when expedited resolution is required, must be followed with a written notice within ten (10) calendar days of the oral filing. The date of oral notice shall constitute the date of receipt. 3. The Health Plan shall provide any reasonable help to the enrollee in completing forms and following the procedures for filing a grievance or appeal or requesting a Medicaid Fair Hearing. This includes interpreter services, toll-free calling, and TTY/TTD capability. 4. The Health Plan shall handle grievances and appeals as follows: a. Provide the enrollee a reasonable opportunity to present evidence and allegations of fact or law in person as well as in writing. b. Ensure the enrollee understands any time limits that may apply. c. Provide opportunity before and during the process for the enrollee or an authorized representative to examine the case file, including medical records, and any other material to be considered during the process. d. Consider as parties to the appeal the enrollee or an authorized representative or, if the enrollee is deceased, the legal representative of the estate. WellCare of AMERIGROUP Florida, Inc., Inc. d/b/a Medicaid HMO Non-Reform and Reform AMERIGROUP Community Care HMO Contract

Filing Grievances and Appeals. 1. A grievance may be filed orally or in writing within one (1) year of the occurrence. 2. An appeal may be filed orally or in writing within thirty (30) calendar days of the enrollee’s receipt of the notice of action and, except when expedited resolution is required, must be followed with a written notice within ten (10) calendar days of the oral filing. The date of oral notice shall constitute the date of receipt. 3. The Health Plan shall provide any reasonable help to the enrollee in completing forms and following the procedures for filing a grievance or appeal or requesting a Medicaid Fair Hearing. This includes interpreter services, toll-free calling, and TTY/TTD capability. 4. The Health Plan shall handle grievances and appeals as follows: a. Provide the enrollee a reasonable opportunity to present evidence and allegations of fact or law in person as well as in writing. b. Ensure the enrollee understands any time limits that may apply. c. Provide opportunity before and during the process for the enrollee or an authorized representative to examine the case file, including medical records, and any other material to be considered during the process. d. Consider as parties to the appeal the enrollee or an authorized representative or, if the enrollee is deceased, the legal representative of the estate. WellCare HealthEase of Florida, Inc., Inc. Medicaid HMO Non-Reform Contract