Common use of Grievances and Appeals Clause in Contracts

Grievances and Appeals. The MAO shall implement the applicable requirements of 42 CFR 422.562(a)(5), and any subsequent regulatory guidance relating to assistance with Medicaid covered service grievances and appeals as detailed in paragraph 2.14 of this Agreement. The MAO shall submit Grievances and Appeals reports in accordance with the requirements of Attachment 1: Chart of Deliverables and the AHCCCS Grievance System Reporting Guide. AHCCCS shall use these reports for informational purposes only. The MAO shall provide AHCCCS with the following information:  A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals,  A quarterly summary of Medicare Independent Review Entity (IRE) decisions received, and  Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).

Grievances and Appeals. The MAO shall implement the applicable requirements of 42 CFR 422.562(a)(5), and any subsequent regulatory guidance relating to assistance with Medicaid covered service grievances and appeals as detailed in paragraph 2.14 of this Agreement. The MAO shall submit Grievances and Appeals reports quarterly in accordance with the requirements of Attachment 1: Chart of Deliverables and using the AHCCCS Grievance System Reporting Guideformat provided by AHCCCS. AHCCCS shall use these reports for informational purposes only. The MAO shall provide AHCCCS with the following information:  • A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals,  ; • A quarterly summary of Medicare Independent Review Entity (IRE) decisions received, ; and  • Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).

Grievances and Appeals. The MAO shall implement the applicable requirements of 42 CFR 422.562(a)(5), and any subsequent regulatory guidance relating to assistance with Medicaid covered service grievances and appeals as detailed in paragraph 2.14 2.13 of this Agreement. The MAO shall submit Grievances and Appeals reports in accordance with the requirements of Attachment 1: Chart of Deliverables and the AHCCCS Grievance System Reporting Guide. AHCCCS shall use these reports for informational purposes only. The MAO shall provide AHCCCS with the following information:  • A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals,  • A quarterly summary of Medicare Independent Review Entity (IRE) decisions received, and  • Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).

Grievances and Appeals. The MAO shall implement the applicable requirements of 42 CFR 422.562(a)(5), and any subsequent regulatory guidance relating to assistance with Medicaid covered service grievances and appeals as detailed in paragraph 2.14 of this Agreement. The MAO shall submit Grievances and Appeals reports quarterly in accordance with the requirements of Attachment 1: Chart of Deliverables and using the AHCCCS Grievance System Reporting Guideformat provided by AHCCCS. AHCCCS shall use these reports for informational purposes only. The MAO shall provide AHCCCS with the following information:  A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals,  ; A quarterly summary of Medicare Independent Review Entity (IRE) decisions received, ; and  Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).