INTERNAL GRIEVANCE PROCEDURE Sample Clauses

INTERNAL GRIEVANCE PROCEDURE. 1. A grievance must be filed within 180 days from the date of receipt of the written notice of any Adverse Benefit Determination. 2. A Member or authorized representative should first contact CareFirst about a denial of benefits. CareFirst can provide information and assistance on how to file a grievance. All grievances filed should be in writing, except grievances involving Urgent/Emergent Care which may be submitted orally or in writing. SAMPLE 3. The Member or authorized representative may submit written comments, documents, records, and other information relating to a claim for benefits. 4. The grievance decision for Urgent/Emergent Care claim shall be made as soon as possible but no later than the earlier of 24 hours after CareFirst’s receipt of the necessary information to make the decision regarding request for coverage, or 72 hours after receipt of the request for coverage. 5. A Member shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Member's claim for benefits. A document, record, or other information shall be considered relevant to a Member's claim if it: a. Was relied upon in making the benefit determination; b. Was submitted, considered, or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination; or, c. Demonstrates compliance with the administrative processes and safeguards designed to ensure and verify that benefit claim determinations are made in accordance with governing plan documents and that, where appropriate, the plan provisions have been applied consistently with respect to similarly situated members. 6. A grievance and any applicable documentation should be sent to the correspondence address stated on the reverse of the Member identification card. 7. Timing of CareFirst responses. The time limits for responding to a grievance will begin at the time an appeal is filed in accordance with these procedures, without regard to whether all the information necessary to make a decision is initially included. CareFirst will make a grievance decision and written notification will be sent: a. Within 30 days after receipt of the grievance for a case involving a Pre- Service Claim; b. Within 60 days after receipt of the grievance for a case involving a Post- Service Claim; and In the case of an expedited appeal regarding a...
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INTERNAL GRIEVANCE PROCEDURE. The MDwise Customer Service Department is responsible for the processing of Grievances. All Grievances are thoroughly researched and documented, and as necessary, are referred for resolution beyond the Customer Services Department. You may file a Grievance in writing or by calling MDwise Customer Service directly and a Customer Service representative will assist You in filing the Grievance. (A) Your Name [and the patient’s name] (B) [The patient’s] Date of Birth (C) Date of Grievance (D) Type of Grievance (E) Summary of the substance of the Grievance (F) Summary of the actions taken. We will document the substance of the Grievance and any actions taken. You are permitted to review the Grievance claim file and to present evidence and testimony as part of the internal claims and appeals process. The MDwise Customer Service Representative appointed to Your Grievance will conduct a thorough investigation of the facts of Your Grievance, including any aspects involving critical care, and make a decision regarding it. Other Providers or individuals We employ may be consulted before the decision is made. Our decision regarding Your Grievance must be made as soon as possible. We will notify you in writing no later than (A) 15 days after the date Your Grievance was filed, for a Pre-service Grievance, and
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INTERNAL GRIEVANCE PROCEDURE. The MDwise Customer Service Department is responsible for the processing of Grievances. All Grievances are thoroughly researched and documented, and as necessary, are referred for resolution beyond the Customer Services Department. You may file a Grievance in writing or by calling MDwise Customer Service directly and a Customer Service representative will assist You in filing the Grievance.
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INTERNAL GRIEVANCE PROCEDURE. I understand that before commencing arbitration under this Agreement, I may attempt to resolve a Claim through COMPANY’s internal procedure for resolving employee grievances in effect at that time.
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INTERNAL GRIEVANCE PROCEDURE 
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Related to INTERNAL GRIEVANCE PROCEDURE

  • GRIEVANCE PROCEDURE An Employee may informally discuss a complaint with his/her supervisor, with or without his/her Grievance Committeeman (Griever) being present. However, if the Employee wishes to use this grievance procedure, s/he shall report the matter to his/her Griever, who must refer it to Step 1 of the grievance procedure by completing a grievance form and submitting it to the Employee’s supervisor within thirty (30) days of the date on which the Employee first knew or should have known of the facts which gave rise to the grievance. The grievance form shall be signed by the Griever and the Employee. The supervisor shall sign and date the grievance form and return a completed copy to the Griever. a. Step 1 – Oral (1) A grievance received in Step 1 shall be discussed at a meeting with the Grievance Committeeman from the area and/or the Griever, the grievant and the grievant’s supervisor at a mutually convenient time within five (5) days of receipt of the grievance form. Management may call any non-represented employee as a witness to provide testimony and/or evidence to the meeting. The Union may call any USW represented Employee as a witness to provide testimony and/or evidence to the meeting. (2) The supervisor shall answer the grievance no later than three (3) days after the Step 1 hearing. If settled in Step 1, the grievance form shall be so noted and signed and dated by the Griever, the Grievance Committeeman and the grievant’s supervisor. (3) If not settled or withdrawn in Step 1, the Union shall, within five (5) days of the Company’s Step 1 response, provide the Company with a written record, signed by the Grievance Committeeman, of the grievance, including the grievance number, a statement of the grievance, the Union’s understanding of the facts, its position and the reasons therefor, the remedy requested and the date submitted. (4) Upon receipt, the Company shall, within three (3) days, provide the Grievance Committeeman and the Chair of the Union’s Grievance Committee (the Grievance Chair) with its version of the written record of the grievance, signed by the Company, with the same set of information required of the Union. These two (2) completed forms shall comprise the Step 1 written record.

  • Grievance Procedures The AGENCY agrees to establish a formal written grievance process with procedures through which clients and recipients of services may present grievances to the governing authority of the AGENCY regarding services being provided under this Contract. Additionally, the AGENCY agrees to establish fair hearing procedures that ensure all persons will be advised of their rights to a fair hearing to appeal a denial or exclusion from services and/or the failure of staff to take into account the individual’s choice of service. The AGENCY’S internal grievance procedure must document and include, at a minimum, the following: date of grievance, a written response to the applicant sent within thirty (30) days, and the opportunity for the applicant to meet with the AGENCY Executive Director or designee. Upon request by the COUNTY, the AGENCY shall provide a written report as to the grievance outcome within five (5) normal COUNTY working days. The AGENCY will maintain these documents on file for review by the COUNTY.

  • Steps of the Grievance Procedure All grievances shall be processed in accordance with the following procedure. Grievances over final counseling or dismissal will begin at Step Two. For all other grievances, the parties may agree to waive Step One. For grievances filed directly at Step Two, the grievant will have thirty (30) calendar days from the occurrence of the situation, condition or action that caused the grievant to file. Within thirty (30) calendar days of the occurrence of a situation, condition, or action that caused the grievance, the employee(s) affected and/or the xxxxxxx or Union representative shall present the grievance to the employee’s immediate supervisor for resolution. The Human Resources Consultant may also attend, if desired by the University. Presentation of the grievance shall include a short written description of the subject of the grievance and the contract Articles allegedly violated. If the grievance is directed against the employee’s immediate supervisor, the grievance may be presented to the next higher level of supervision. In the event the employee’s immediate supervisor does not have authority to resolve the grievance, the grievance will be presented at the level having authority to act as determined by the Employer. The Employer will respond within five (5) calendar days of the meeting. In the event an employee files a grievance outside the department in which the employee is employed and the grievance cannot be resolved at Step One, the grievance will be processed at Step Two by the level of management as designated by the University in the department which has been named in the grievance. If a satisfactory settlement is not reached in Step One, and the employee wishes to pursue the matter further, said grievance shall be put into writing on the agreed upon grievance form and referred to the department head or designee or to the next appropriate level of management and the Office of Labor Relations within fifteen (15) calendar days after the decision from Step One. The date of alleged occurrence of the grievance shall be specified. The parties shall attempt to meet to resolve the grievance within fifteen (15) calendar days following the date of written submittal. At this step, the Union agrees to cite all known sections of the Agreement and/or written policy or practice allegedly violated and to provide a copy to the Human Resources Office and Office of Labor Relations. The grievant may be represented by a xxxxxxx and a union staff representative. The University will be represented by the appropriate management official(s) or designee(s), a representative from the Office of Labor Relations, and a Human Resources Consultant, if desired by the University. The University will respond in writing within ten (10) calendar days.

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