GRIEVANCE AND APPEALS SYSTEM. In accordance with 42 C.F.R. §438.400.,the processes the MCO, PIHP, or PAHP implements to handle appeals of an adverse benefit determination and grievances, as well as the processes to collect and track information about grievances and appeals.
GRIEVANCE AND APPEALS SYSTEM. The Contractor shall give a copy of the written notice to the Department at the time the notice is sent to the Enrollee.
GRIEVANCE AND APPEALS SYSTEM. (a) Based on the number of deficiencies across all Cigna lines of business pertaining to grievances, Cigna shall improve its California grievance and appeals systems, improve its enrollee and provider notification mechanisms, processes, and letter content, and improve the quality and frequency of training of Customer Service Representatives.
GRIEVANCE AND APPEALS SYSTEM. Contractor shall ensure staff is knowledgeable of and compliant with State law and DBH policy/procedure regarding beneficiary problem resolution, the grievance and appeal system, including timing, procedures, handling, resolution and notification, expedited resolution, recordkeeping, reversed appeal resolutions and continued benefits while appeals and state fair hearings are pending, in accordance with 42 CFR §§438.228, 438.402, 438.406, 438.408, 438.410, 438.416, 438.420, and 438.424.
