Grievances, Appeals, and State Hearings Logs and Record-Keeping. The MCO must log and keep records of grievances, appeals, and state hearings documenting MCO performance of all state and federal requirements (e.g., timely acknowledgement, continuation of benefits when applicable) that in accordance with 42 CFR 438.416 must include: The name of the member for whom the appeal, grievance, or state hearing was filed; The date the appeal, grievance, or state hearing was received; A general description of the reason for the appeal, grievance, or state hearing; The date of each review or, if applicable, review meeting; If applicable, the resolution of the appeal, grievance, or state hearing; and If applicable, the date of the resolution.
Appears in 4 contracts
Samples: Baseline Provider Agreement, Baseline Provider Agreement, Baseline Provider Agreement
