Member Appeals Sample Clauses

Member Appeals. A Member receiving notice of an alleged breach and 22 proposed liquidated damages shall have five (5) days from the date that the Member receives the notice 23 to request an appeal hearing before the Enforcement Committee. If a Member fails to request a hearing 24 within such 5-day appeal period, the Member’s right of appeal shall expire, the Member shall be 25 deemed to have breached this Agreement in accordance with the Manager’s determination, and the 26 Member shall be obligated to pay the related liquidated damages. If a Member timely requests an 27 appeal hearing, the Manager shall consult with the Enforcement Committee and schedule an 28 Enforcement Committee meeting for that purpose. The Enforcement Committee shall make reasonable 29 efforts to schedule the meeting at a time and place such that the Member requesting the appeal is able 30 to attend, and shall provide the Member with at least thirty (30) days advance written notice of the time 31 and place of the meeting. At such meeting, the Enforcement Committee shall provide the Manager with 1 an opportunity to present evidence of the apparent breach, and shall provide the Member in apparent 2 breach with a reasonable opportunity to rebut such evidence. Per Section 9, above, the catch and 3 delivery data produced by the Manager shall be presumed accurate, and, absent manifest error, each 4 Member's obligations under this Agreement and all related documents may be enforced to their fullest 5 extent on the basis of such data. If the Enforcement Committee determines that a Member breached 6 this Agreement, the Sector shall have the right to collect from such Member the liquidated damages 7 amount provided for such breach under this Agreement.
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Member Appeals. A Member receiving notice of an alleged breach and proposed liquidated damages shall have five (5) days from the date that the Member receives the notice to request an appeal hearing before the Enforcement Committee. If a Member fails to request a hearing within such 5‐day appeal period, the Member’s right of appeal shall expire, the Member shall be deemed to have breached this Agreement in accordance with the Manager’s determination, and the Member shall be obligated to pay the related liquidated damages. If a Member timely requests an appeal hearing, the Manager shall consult with the Enforcement Committee and schedule an Enforcement Committee meeting for that purpose. The Enforcement Committee shall make reasonable efforts to schedule the meeting at a time and place such that the Member requesting the appeal is able to attend, and shall provide the Member with at least thirty (30) days advance written notice of the time and place of the meeting. At such meeting, the Enforcement Committee shall provide the Manager with an opportunity to present evidence of the apparent breach, and shall provide the Member in apparent breach with a reasonable opportunity to rebut such evidence. Per Section 9, above, the catch and delivery data produced by the Manager shall be presumed accurate, and, absent manifest error, each Member's obligations under this Agreement and all related documents may be enforced to their fullest extent on the basis of such data. If the Enforcement Committee determines that a Member breached this Agreement, the Sector shall have the right to collect from such Member the liquidated damages amount provided for such breach under this Agreement.
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Member Appeals. Contractor must resolve one hundred percent (100%) of member appeals within thirty (30) calendar days of receipt of the appeal. For each quarter in which in which Contractor fails to provide and communicate a timely resolution on one hundred percent (100%) of member appeals, Contractor shall pay liquidated damages in the amount of two thousand, two hundred dollars ($2,200). The Contractor must also provide a timely and satisfactory response to documentation required to facilitate member appeals in accordance with the FSSA Fair Hearing process. In addition, the Contractor shall provide a representative to participate in the FSSA fair hearing process to represent the State. For each instance in which the Contractor fails to either (i) provide a timely response to documentation required for the member appeal within the time frames set forth by FSSA, or (ii) upon adequate notice, represent the State at the FSSA fair hearing, Contractor shall pay liquidated damages in the amount of one thousand, fifty dollars ($1,050).
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Member Appeals. County must provide written notification to providers on member grievance procedures as outlined in this Contract. I. PAYMENTS FOR DIAGNOSIS OF WHETHER AN EMERGENCY CONDITION EXISTS Pay for appropriate diagnostic tests or evaluations utilized to determine if an emergency exists. Payment for emergency services continues until the patient is stabilized and can be safely discharged or transferred. J. MEMORANDA OF UNDERSTANDING (MOU) FOR EMERGENCY SERVICES AND POST-STABILIZATOIN SERVICES Negotiate in good faith MOUs with emergency care providers to ensure prompt and appropriate delivery of and payment for emergency services. Such MOUs shall provide for: 1. The process for determining whether an emergency exists. 2. The requirements and procedures for contacting the County before the provision of urgent or routine care. 3. Agreements, if any, between the County and the provider regarding indemnification, hold harmless, or any other deviation from malpractice or other legal liability which would attach to the County or provider in the absence of such an agreement. 4. Payments for appropriate diagnostic tests or evaluations to determine if an emergency exists. 5. Assurance of timely and appropriate provision of and payment for emergency services. Unless a Contract or MOU specifies otherwise, the County is liable to the extent that the fee-for-service system would have been liable for the emergency situation. The Department reserves the right to resolve disputes between the County, hospitals and urgent care centers regarding emergency situations based on fee-for-service criteria.
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Member Appeals. A Member receiving notice of an alleged breach and 15 proposed liquidated damages shall have five (5) days from the date that the Member receives the notice 16 to request an appeal hearing before the Enforcement Committee. If a Member fails to request a hearing 17 within such 5-day appeal period, the Member’s right of appeal shall expire, the Member shall be 18 deemed to have breached this Agreement in accordance with the Manager’s determination, and the 20 appeal hearing, the Manager shall consult with the Enforcement Committee and schedule an 21 Enforcement Committee meeting for that purpose. The Enforcement Committee shall make reasonable 22 efforts to schedule the meeting at a time and place such that the Member requesting the appeal is able 23 to attend, and shall provide the Member with at least thirty (30) days advance written notice of the time 24 and place of the meeting. At such meeting, the Enforcement Committee shall provide the Manager with 25 an opportunity to present evidence of the apparent breach, and shall provide the Member in apparent 26 breach with a reasonable opportunity to rebut such evidence. Per Section 9, above, the catch and 27 delivery data produced by the Manager shall be presumed accurate, and, absent manifest error, each 28 Member's obligations under this Agreement and all related documents may be enforced to their fullest 29 extent on the basis of such data. If the Enforcement Committee determines that a Member breached 30 this Agreement, the Sector shall have the right to collect from such Member the liquidated damages 31 amount provided for such breach under this Agreement.
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Member Appeals. A Member receiving notice of an alleged breach and 7 proposed liquidated damages shall have five (5) days from the date that the Member receives the notice 8 to request an appeal hearing before the Enforcement Committee. If a Member fails to request a hearing 9 within such 5‐day appeal period, the Member’s right of appeal shall expire, the Member shall be deemed 10 to have breached this Agreement in accordance with the Manager’s determination, and the Member shall 11 be obligated to pay the related liquidated damages. If a Member timely requests an appeal hearing, the 12 Manager shall consult with the Enforcement Committee and schedule an Enforcement Committee 13 meeting for that purpose. The Enforcement Committee shall make reasonable efforts to schedule the 14 meeting at a time and place such that the Member requesting the appeal is able to attend, and shall 15 provide the Member with at least thirty (30) days advance written notice of the time and place of the
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Member Appeals. All Member appeals shall be resolved in accordance with the provisions of the applicable Membership Agreement or EOC.
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Member Appeals. A Member receiving notice of an alleged breach and
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Related to Member Appeals

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • Grievance Committee The Hospital will recognize a Grievance Committee composed of the Chief ▇▇▇▇▇▇▇ and not more than (as set out in Local Provisions Appendix) employees selected by the Union who have completed their probationary period. A general representative of the Union may be present at any meeting of the Committee. The purpose of the Committee is to deal with complaints or grievances as set out in this Collective Agreement. The Union shall keep the Hospital notified in writing of the names of the members of the Grievance Committee appointed or selected under this Article as well as the effective date of their respective appointments. A Committee member shall suffer no loss of earnings for time spent during their regular scheduled working hours in attending grievance meetings with the Hospital up to, but not including arbitration. The number of employees on the Grievance Committee shall be determined locally.