General Requirements for Grievance & Appeals Sample Clauses

General Requirements for Grievance & Appeals. The CONTRACTOR shall: A. implement written policies and procedures describing how the member may register a grievance or an appeal with the CONTRACTOR and how the CONTRACTOR resolves the grievance or appeal and meet all requirements in MAD Program Manual Section 8.305.12 NMAC; B. provide a copy of its policies and procedures for resolution of a grievance and/or an appeal to all service providers in the CONTRACTOR’S network; C. have available reasonable assistance in completing forms and taking other procedural steps. This includes, but is not limited to, providing interpreter services and toll-free numbers that have adequate TTY/TTD and interpreter capability; D. name a specific individual(s) designated as the CONTRACTOR’S Medicaid member grievance coordinator with the authority to administer the policies and procedures for resolution of a grievance and/or an appeal, to review patterns/trends in grievances and/or appeals, and to initiate corrective action; E. ensure that the individuals who make decisions on grievances and/or appeals are not involved in any previous level of review or decision-making. The CONTRACTOR shall also ensure that health care professionals with appropriate clinical expertise will make decisions for the following: i. an appeal of a CONTRACTOR denial that is based on lack of medical necessity; ii. a CONTRACTOR denial that is upheld in an expedited resolution; and iii. a grievance or appeal that involves clinical issues; F. provide members, within thirty (30) calendar days of enrollment and at no cost, with a member information sheet or handbook that provides information on how they and/or their representative(s) can file a grievance and/or an appeal, and the resolution process. The member information shall also advise members of their right to file a request for an administrative hearing with the HSD/MAD Hearings Bureau, upon notification of a CONTRACTOR action, or concurrent with or following an appeal of the CONTRACTOR action. The information shall meet the standards for communication specified in MAD Program Manual Section 8.305.8.15.(13); and G. ensure that punitive or retaliatory action is not taken against a member or a provider that files a grievance and/or an appeal, or against a provider that supports a member’s grievance and/or appeal.
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General Requirements for Grievance & Appeals. The CONTRACTOR shall implement written policies and procedures describing how the member may register a grievance or an appeal with the CONTRACTOR and how the CONTRACTOR resolves the grievance or appeal.

Related to General Requirements for Grievance & Appeals

  • Grievance Commissioner System This is to confirm the discussion of the parties during collective bargaining that they are committed to encouraging early discussion and resolution of labour relations issues at the local level and seek to resolve grievances in a timely and cost efficient manner. To that end, this is to confirm that pursuant to Article 8, the parties agree that the Employer and Union at individual nursing homes may agree to utilize the following process in order to resolve a particular grievance through the utilization of a joint mediation-arbitration procedure:

  • Statement of Grievance The grievance shall contain a statement of: 1. Specific situation, act or acts complained of as violation of this Agreement, or written rules, regulations or policies; 2. The damage suffered by the employee; and 3. The relief sought.

  • Submission of Grievance Information a. Upon appointment of the arbitrator, the appealing party shall, within five (5) days after notice of appointment, forward to the arbitrator, with a copy to the School Board, the submission of the grievance which shall include the following: 1. The issues involved. 2. Statement of the facts. 3. Position of the grievant. 4. The written documents relating to Section 5 of the grievance procedure.

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • 000 GRIEVANCE PROCEDURE 7. 100 It is agreed that it is the spirit and intent of this Agreement to adjust grievances promptly. All grievances, including discharge for just cause, but not those pertaining to jurisdictional disputes that may arise on any work covered by this Agreement, must be initiated within fifteen (15) working days of the incident by either the employee in Step I or the Local Union in Step II and shall be handled in the following manner:

  • Technical Objections to Grievances It is the intent of both Parties of this Agreement that no grievance shall be defeated merely because of a technical error, other than time limitations in processing the grievance through the grievance procedure. To this end, an arbitration board shall have the power to allow all necessary amendments to the grievance and the power to waive formal procedural irregularities in the processing of a grievance, in order to determine the real matter in dispute and to render a decision according to equitable principles and the justice of the case.

  • Review and Procedure Limitations The Asset Representations Reviewer will have no obligation (i) to determine whether a Delinquency Trigger has occurred, (ii) to determine whether the required percentage of Noteholders has voted to direct a Review, (iii) to determine which Receivables are subject to a Review, (iv) to obtain or confirm the validity of the Review Materials, (v) to obtain missing or insufficient Review Materials (except to the extent set forth in Section 3.04), or (vi) to take any action or cause any other party to take any action under any of the Basic Documents to enforce any remedies for breaches of any Eligible Representations. The Asset Representations Reviewer will only be required to perform the Tests provided in Exhibit A and will have no obligation to perform additional testing procedures on any ARR Receivables or to consider any additional information provided by any party. The Asset Representations Reviewer will have no obligation to provide reporting or information in addition to that described in Section 3.07. However, the Asset Representations Reviewer may review and report on additional information that it determines in good faith to be material to its performance under this ARR Agreement and may re-perform a Review with respect to an ARR Receivable as contemplated by Section 3.09. The Issuing Entity expressly agrees that the Asset Representations Reviewer is not advising the Issuing Entity or any Noteholder or any investor or future investor concerning the suitability of the Notes or any investment strategy. The Issuing Entity expressly acknowledges and agrees that the Asset Representations Reviewer is not an expert in accounting, tax, regulatory, or legal matters, and that the Asset Representations Reviewer is not providing legal advice as to any matter.

  • Submission of Grievances A. Any employee or group of employees shall have the right to present a grievance. No employee or group of employees shall be hindered from or disciplined for exercising this right. B. If any two (2) or more employees have essentially the same grievance they may, and if requested by the County must, collectively present and pursue their grievance if they report to the same immediate supervisor. C. If the grievant is a group of more than three (3) employees, the group shall, at the request of the County, appoint one (1) or two (2) employees to speak for the collective group. To be considered a grievant in a group grievance, each employee must be individually identified as a grievant when the grievance is submitted at Step 2.

  • Grievance on Layoffs and Recalls Grievances concerning layoffs and recalls shall be initiated at Step 2 of the grievance procedure.

  • Grievance Redressal Level 1 We are committed to resolving your queries/issues within 7 working days. If you do not hear from us within this time, or you are not satisfied with our resolution of your query, the customer may write to us at xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxx.xx Level 2 If the customer is not satisfied with the resolution provided at level 1 within 2 working days, the customer may post his/her complaint to the head of Customer Experience at xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxx.xx Alternatively, the customers may write to The Head of Customer Experience at: Bajaj Housing Finance Limited, 5th Floor, B2 Cerebrum IT Park, Kumar City Kalyani Nagar Pune, Maharashtra Pin – 411014 Level 3 If the customer is not satisfied with the resolution provided at level 1 within 2 working days, the customer may post his/her complaint to the head of Customer Experience at xxxx.xxxxxx@xxxxxxxxxxxx.xx Alternatively, the customers may write to National Manager – Service: Xxxx Xxxxxx Bajaj Housing Finance Limited, 5th Floor, B2 Cerebrum IT Park, Kumar City Kalyani Nagar Pune, Maharashtra Pin – 411014 Level 4 In case of non-redressal of the complaint to the customer’s satisfaction, within 7 working days from the above-mentioned matrix, the customer may approach the National Housing Bank by lodging its complaint in online mode at the link xxxxx://xxxxx.xxxxxxxxx.xxx.xx or in offline mode by post at the address given below in the prescribed format available at link (xxxx://xxx.xxx.xx/citizencharter/NHB%20Grievance%20Redressal%20Policy.pdf) National Housing Bank, Department of Regulation and Supervision, (Complaint Redressal Cell), 4th Floor, Core-5A, India Habitat Centre, Lodhi Road, New Delhi- 110003 The below-mentioned process is followed when a Xxxxxxxx writes to xxxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxx.xx : • Customer service associate reads the entire email to understand the customer query • Xxxxxxxx is contacted to understand his/its requirements • Grievance Team coordinates with internal departments to get the complaint resolved as per the defined timeline. • If the resolution is not possible within the defined TAT of 7 working days, due to internal and external dependencies, interim response along with timelines is sent to the Borrower. • All queries are closed on e-mail and via telephone call. Timely update is sent to the Borrower in case of any extension required in committed timelines.

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