Member Complaints is replaced with the following language:
Member Complaints. When an administrator receives a complaint about a situation between two or more members, the administration may inform the Association. The Association and the administration will work together to initiate a mediation process with the involved members.
Member Complaints. To submit periodically to the Board of Directors an analysis of Member complaints and to take any corrective action required or to recommend appropriate revisions in Board policy.
Member Complaints. 16.1 Physicians Care and the Hospital agree, to the extent permitted by law, fully to advise each other of any Member complaint, grievance or claim known to that party relating to services provided under this Agreement.
16.2 Physicians Care maintains a grievance process for Members in accordance with applicable state and federal law, and the applicable Subscriber Agreement. Hospital agrees to cooperate with Physicians Care in its resolution of Member complaints and grievances.
Member Complaints. HMO must submit a quarterly summary report of Member complaints. The report must show the date upon which each complaint was filed, a summary of the facts surrounding the complaint, the date of the resolution of the complaint, an explanation of the procedure followed, and the outcome of the complaint process. It should also include the Member Advocate Report (refer to Article 8.
Member Complaints. HMO must submit a quarterly summary report of Member complaints. HMO must also report complaints submitted to its subcontracted risk groups (e.g., IPAs). The complaint report format must be submitted to TDH as two paper copies and one electronic copy on or before 45 days following the end of the state fiscal quarter using a form specified by TDH.
Member Complaints. Vision Group shall notify HMSA of all Member complaints made to Vision Group and Participating Providers regarding the quality of care provided or allegations or professional incompetence or professional misconduct in connection with Covered Services provided by Vision Group.
Member Complaints. The CONTRACTOR shall submit a quarterly Member Complaints Report (see Section 2.19.2) that includes current information, by month, as well as cumulative information regarding specified measures, an exceptions report (as needed), a cumulative report, a summary report, and a performance improvement plan (as applicable). The performance measures for the first twelve (12) months after CHOICES implementation shall include but not be limited to the following:
(1) The number of complaints received in the month, overall, by type, and by CHOICES Group (if the member is a CHOICES member)
(2) The number and percent of complaints received in the month, overall and by CHOICES Group (if applicable), that were/were not resolved within five (5) business days via a call with the member (see Section 2.19.2)
(3) Of complaints that were not resolved within five (5) business days via a call with the member and for which resolution is due, the number and percent of complaints for which the CONTRACTOR met/did not meet the specified timeframe for resolution and notice of resolution (see Section 2.19.2.5)
(4) Of complaints that were not resolved within five (5) business days via a call with the member, the minimum, maximum, median, and average amount of time that the CONTRACTOR took to resolve complaints and notify members of resolution Starting the thirteenth month after CHOICES implementation, the performance measures shall include but not be limited to the performance measures from the first twelve (12) month as well as the following performance measure:
(1) Of complaints that were not resolved within five (5) business days via a call with the member and for which acknowledgement is due, the number and percent for which the CONTRACTOR met/did not meet the specified timeframe for sending a notice of acknowledgement (see Section 2.19.2.5) If the CONTRACTOR’s performance for any one of the timeframe measures is less than one hundred percent (100%), the CONTRACTOR shall provide an exceptions report for that measure. The report shall identify the number and percent of members for whom the CONTRACTOR did not meet the specified timeframe and provide detail information regarding each instance in which the CONTRACTOR did not meet the applicable timeframe. The detail information shall include but not be limited to for each member: the date the applicable activity should have occurred, the actual date that the applicable activity occurred (if it occurred within the reporting period), the ...
Member Complaints. Upon receipt of a reporting template from TENNCARE and in accordance with specified timeframes for implementing the new report, the CONTRACTOR shall begin submitting a quarterly Member Complaints Report (see Section 2.19.2) that includes information, by month, regarding specified measures, which shall include but not be limited to the following:
(1) The number of complaints received in the month, overall, by type, and by CHOICES Group (if the member is a CHOICES member)
(2) The number and percent of complaints for which the CONTRACTOR met/did not meet the specified timeframe for resolution (see Section 2.19.
Member Complaints. If any complaints are received from Members by Contracted Provider regarding Contracted Provider, Participating Providers, or HMC, Contracted Provider agrees to promptly notify HMC concerning all details of such complaint. If such complaints regarding Contracted Provider are received directly by HMC, HMC will promptly notify Contracted Provider. Contracted Provider and HMC agree to cooperate fully towards the investigation and resolution of any such complaint by a Member.
