Grievance Processing Requirements Sample Clauses

Grievance Processing Requirements. In accordance with 42 CFR 438.402, members shall be allowed to file grievances orally or in writing. Members may file a grievance regarding any matter other than those described in the definition of an action as described in this Section 4.9. Grievances may be filed within sixty (60) calendar days of the occurrence of the matter that is the subject of the grievance. The Contractor shall acknowledge receipt of each grievance within three (3) business days. The Contractor shall make a decision on non-expedited grievances as expeditiously as possible, but not more than thirty (30) calendar days following receipt of the grievance. This timeframe may be extended up to fourteen (14) calendar days if resolution of the matter requires additional time. If the timeframe is extended, for any extension not requested by the member, the Contractor shall give the member written notice of the reason for the delay. The Contractor shall provide the member with a written notice of any extension within two (2) calendar days of the extension, including the reason for the extension and the member’s right to file a grievance if they disagree with the extension. The Contractor shall provide an expedited grievance review if adhering to the resolution timeframe of thirty (30) calendar days would seriously jeopardize the life or health of a member, or the member’s ability to regain maximum function. Expedited grievances must be resolved within forty-eight (48) hours of receipt. If the Contractor denies a request for an expedited review, the Contractor shall transfer the grievance to the standard grievance timeframe. Further, the Contractor must make a reasonable effort, including a phone call to the member, to provide the member with prompt oral notification of the denial for an expedited review, and shall follow up with a written notice within two (2) calendar days. The Contractor shall respond in writing to a member within five (5) business days after resolving a grievance or expedited grievance. The resolution includes notice of the member’s right to file an appeal if applicable, the process for requesting an appeal, the expedited review options, the right to continue benefits during the appeal (as long as the request complies with timeliness standards), and an explanation that the member may have to pay for care received if an adverse appeal decision is made. The Contractor shall make a reasonable effort, including a phone call to the member, to provide oral notification of expe...
AutoNDA by SimpleDocs
Grievance Processing Requirements. In accordance with 42 CFR 438.402, members shall be allowed to file grievances orally or in writing. Members may file a grievance regarding any matter other than those described in the definition of an action as described in this Section
Grievance Processing Requirements. In accordance with 42 CFR 438.402, members must be allowed to file grievances orally or in writing. Members may file a grievance regarding any matter other than those described in the definition of an action as described in Section 4.12. Grievances may be filed within sixty (60) calendar days of the occurrence of the matter that is the subject of the grievance. The Contractor must acknowledge receipt of each grievance within three (3) business days. The Contractor must make a decision on non-expedited grievances as expeditiously as possible, but not more than thirty (30) calendar days following receipt of the grievance. This timeframe may be extended up to ten
Grievance Processing Requirements. In accordance with 42 CFR 438.402(c)(2)(i) and 42 CFR 438.402(c)(3)(i), members must be allowed to file grievances orally or in writing at any time. Members may file a grievance regarding any matter other than those described in the definition of an adverse benefit determination as described in Section 4.12. Grievances must be filed within sixty (60) calendar days of the occurrence of the matter that is the subject of the grievance. The Contractor must acknowledge receipt of each grievance within three (3) business days. In accordance with 42 CFR 438.408(a) and 42 CFR 438.408(b)(1), the Contractor must make a decision on non-expedited grievances as expeditiously as possible, but not more than thirty (30) calendar days following receipt of the grievance. This timeframe may be extended up to fourteen (14) calendar days if the enrollee requests the extension or the Contractor shows there is need for additional information and the delay is in the member’s interest (upon State request) as required by 42 CFR 438.408(c)(1)(i) - (ii); 438.408(b)(1). In accordance with 42 CFR 438.408(c)(2)(i) - (ii) and 42 CFR 438.408(b)(1), if the timeframe is extended, for any extension not requested by the member, the Contractor shall make reasonable efforts to give the enrollee prompt oral notice of the delay and must give the member written notice of the reason for the delay within two (2) calendar days of the extension, including the reason for the extension and the member’s right to file a grievance if they disagree with the extension. The Contractor shall provide an expedited grievance review if adhering to the resolution timeframe of thirty (30) calendar days would seriously jeopardize the life or health of a member, or the member’s ability to regain maximum function. Expedited grievances must be resolved within forty-eight (48) hours of receipt. If the Contractor denies a request for an expedited review, the Contractor shall transfer the grievance to the standard grievance timeframe per 42 CFR 438.410(c), 42 CFR 438.408(b)(2) and 42 CFR 438.408(c)(2). Further, the Contractor must make a reasonable effort, including a phone call to the member, to provide the member with prompt oral notification of the denial for an expedited review, and shall follow up with a written notice to the member and, where appropriate, the provider within two (2) calendar days.
Grievance Processing Requirements. In accordance with 42 CFR 438.402(c)(2)(i) and 42 CFR 438.402(c)(3)(i), members must be allowed to file grievances orally or in writing at any time. Members may file a grievance regarding any matter other than those described in the definition of an adverse benefit determination as described in Section 4.12. Grievances must be filed within sixty (60) calendar days of the occurrence of the matter that is the subject of the grievance. The Contractor must acknowledge receipt of each grievance within three (3) business days. In accordance with 42 CFR 438.408(a) and 42 CFR 438.408(b)(1), the

Related to Grievance Processing Requirements

  • Staffing Requirements Licensee will be in full compliance with the main studio staff requirements as specified by the FCC.

  • Trunking Requirements The Parties will provide designed Interconnection facilities that meet the same technical criteria and service standards, such as probability of blocking in peak hours and transmission standards, in accordance with current industry standards.

  • Forecasting Requirements 19.5.1 The Parties shall exchange technical descriptions and forecasts of their Interconnection and traffic requirements in sufficient detail necessary to establish the Interconnections necessary for traffic completion to and from all Customers in their respective designated service areas.

  • Bonding Requirements The Contractor is required to furnish a performance bond on the form in a form acceptable to the City, in a sum of not less than [insert bonding level] of the annual amount of the contract to guarantee the faithful performance of this contract. The bond must be approved as to sufficiency and qualifications of the surety by the Controller.

  • Monitoring Requirements This Schedule sets out the contract management requirements which are applicable to the delivery of the Services.

  • Training Requirements Grantee shall: A. Authorize and require staff (including volunteers) to attend training, conferences, and meetings as directed by DSHS; B. Appropriately budget funds in order to meet training requirements in a timely manner, and ensure that staff and volunteers are trained as specified in the training requirements listed at xxxxx://xxx.xxxx.xxxxx.xxx/hivstd/training/ and as otherwise specified by DSHS. Grantee shall document that these training requirements are met; and C. Ensure that staff hired for HIV and syphilis testing are trained to perform blood draws within three (3) months of employment.

  • Operating Requirements Any operating and technical requirements that may be applicable due to Regional Transmission Organization, Independent System Operator, control area, or the Connecting Transmission Owner’s requirements, including those set forth in the Small Generator Interconnection Agreement. Operating Requirements shall include Applicable Reliability Standards.

  • INVOICING REQUIREMENTS A. Upon acceptance of work by the Service Coordinator, the Contractor shall submit the invoice (and supporting documents where applicable) to the appropriate County department per the issued Delivery Order within thirty (30) calendar days of the acceptance. At minimum, all invoice shall contain the following information: • Correct Delivery Order number • Description of work performed to include the manufacturer name, original make and model number(s) of parts and equipment installed. • Start and ending date of the work • Location of the work • Total labor categorized per the Bid Response Form and rounded to the nearest (30) minutes • Itemized list of materials used according to the original manufacturer’s part name and part number. ▪ Unit price and quantity shall be provided on the invoice for each part • Applicable sales tax for materials purchased should be listed separately • Markdown/mark-ups for material shall be listed as a line item on the invoice. • Approved shipping charges shall be listed separately • Permit and special equipment rental cost for reimbursement (if applicable) • Invoice total B. Proof of purchase for all reimbursable expense must be submitted with the invoice showing the actual cost for all reimbursable expenses by the County, including but not limited to, parts, shipping, sales tax, permits, specialty equipment rentals, etc. The Contractor shall provide a separate service ticket for each work day as verification of actual labor spent on the project daily. C. The Contractor shall not combine charges for multiple Delivery Orders on the same invoice. Each Delivery Order must be invoiced separately. D. The County will review invoices for the required information. The County will have the authority to reject invoices based on improper invoice format and lack of supporting documents. E. The Contractor shall not invoice the County for any work not accepted by the County. Should the County received such invoices, they will be rejected. F. Unless otherwise authorized by the corresponding department in writing, delivery of invoices and back-up documentation via e-mail and/or fax is not allowed under this contract. All invoices shall be mailed or hand delivered to the appropriate Department as referenced as the “Invoice To:” location and on the Delivery Order. G. The Contractor shall submit monthly statements of unpaid invoices to each department ordering services under this contract. The Contractor shall not combine statements for different Departments utilizing this contract. • Statement date • Invoice numbers • Invoice dates • Invoice total or unpaid balance if different from invoice total • Delivery order number corresponding to each invoice listed • Balance carry forward • Cumulative outstanding balance Statements shall be sent to the corresponding Department’s, fiscal department, and the Contract Administrator by the 15th day of each month for service performed in the prior month and upon request by the County.

  • Testing Requirements 12.1. Workplaces - 12.2. On workplaces where the value of the Commonwealth’s contribution to the project that includes the building work is at least $5,000,000, and represents at least 50% of the total construction project value or the Commonwealth’s contribution to the project that includes the building work is at least $10,000,000 (irrespective of its proportion of the total construction project value) the following minimum testing requirements must be adhered to.

  • Child Abuse Reporting Requirements A. Grantees shall comply with child abuse and neglect reporting requirements in Texas Family Code Chapter 261. This section is in addition to and does not supersede any other legal obligation of the Grantee to report child abuse. B. Grantee shall use the Texas Abuse Hotline Website located at xxxxx://xxx.xxxxxxxxxxxxxx.xxx/Login/Default.aspx as required by the System Agency. Grantee shall retain reporting documentation on site and make it available for inspection by the System Agency.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!