Grievance and/or Appeal Files. (1) All Grievance and/or Appeal files shall be maintained in a secure, designated area and be accessible to HSD upon request, for review. Grievance and/or Appeal files shall be retained for ten (10) years following the final decision by the CONTRACTOR, HSD, judicial appeal, or closure of a file, whichever occurs later.
Grievance and/or Appeal Files. All Member Grievance and/or Appeal and Provider complaint files shall be maintained in a secure, designated area and be accessible to HCA upon request, for review. Grievance, Appeal, and Provider complaint files shall be retained for ten (10) years following the final decision by the CONTRACTOR, HCA Judicial Appeal or closure of a file, whichever occurs later. The CONTRACTOR will have procedures for ensuring that files contain sufficient information to identify the Grievance, Appeal, and/or Provider complaint; the date it was received; the nature of the Grievance, Appeal, and/or Provider complaint; notice to the Member of receipt of the Grievance and/or Appeal or notice to the Provider of receipt of the Provider complaint; all correspondence between the CONTRACTOR and the Member, the Member’s Representative(s), and/or the Provider; the date the Grievance, Appeal, and/or Provider complaint is resolved; the resolution and notices of final decision to the Member, the Member’s Representative(s) and/or Provider; and all other pertinent information. Documentation regarding the Grievance and/or Appeal shall be made available to the Member, if requested.
Grievance and/or Appeal Files i. All grievance and/or appeal files shall be maintained in a secure, designated area and be accessible to HSD/MAD upon request, for
Grievance and/or Appeal Files. All Member Grievance and/or Appeal and Provider complaint files shall be maintained in a secure, designated area and be accessible to HSD upon request, for review. Grievance, Appeal, and Provider complaint files shall be retained for ten (10) years following the final decision by the CONTRACTOR, HSD, judicial Appeal or closure of a file, whichever occurs later. The CONTRACTOR will have procedures for ensuring that files contain sufficient information to identify the Grievance, Appeal, and/or Provider complaint; the date it was received; the nature of the Grievance, Appeal, and/or Provider complaint; notice to the Member of receipt of the Grievance and/or Appeal or notice to the Provider of receipt of the Provider complaint; all correspondence between the CONTRACTOR and the Member, the Member’s Representative(s), and/or the Provider; the date the Grievance, Appeal, and/or Provider complaint is resolved; the resolution and notices of final decision to the Member, the Member’s Representative(s) and/or Provider; and all other pertinent information. Documentation regarding the Grievance and/or Appeal shall be made available to the Member, if requested. Program Integrity Related Records, Books, and Documents The CONTRACTOR agrees to maintain and require its Major Subcontractors and Subcontractors to maintain, records, books, documents and information on ownership and control, as required in 42 C.F.R. § 455.104 and prohibited affiliations, as specified in 42 C.F.R. § 438.610. The records, books, documents and information in Section 7.17.2.1 of this Agreement shall be maintained for a period of ten (10) years after this Agreement is terminated or until the resolution of all litigation, Claims, financial management reviews or audits pertaining to this Agreement, whichever is longer.
