Member Grievances Sample Clauses

Member Grievances a. The Provider shall address all clinical concerns of the Member as related to the clinical Services provided to the Member pursuant to this Contract. Provider shall refer any unresolved concerns or requests for Services or provider change to the Alliance. The Provider shall have in place a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said process is accessible to all Members and that said process operates in a fair and impartial fashion. b. Alliance may receive complaints directly that involve the Provider. If a complaint is received by Alliance, State rules and regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, Alliance may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. Provider is required to cooperate fully with all investigative requests as required by Controlling Authority. c. Alliance will maintain documentation on all follow up and findings of any complaint investigation. The Provider will be provided a written summary of Alliance’s findings. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the Provider may be required to document and implement a plan of correction as required by Controlling Authority. The Provider will maintain a system to receive and respond timely to complaints received regarding the Provider. The Provider will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved and will provide this documentation to Alliance upon request.

Member Grievances. PROVIDER, the PROVIDER physicians and PROVIDER non-physician providers shall comply with the terms of PLAN’s Medicare grievance and appeals procedures, including expedited appeals, whereby PROVIDER Medicare Members’ complaints relating to PROVIDER physicians and PROVIDER may be filed and addressed, including the gathering and forwarding of information on appeal to PLAN, if necessary; provided, however, that any such procedure shall permit PROVIDER to take reasonable steps necessary to address a grievance or appeal (including, without limitation, initiating disciplinary actions) with PROVIDER physicians or PROVIDER non-physician providers prior to PLAN taking corrective action to the extent Florida law and NCQA standards (if applicable) permit such a delegation of authority by a health maintenance organization. PROVIDER shall provide written notice to PLAN of all grievances and appeals received by PROVIDER from PROVIDER Medicare Members within three (3) business days of such receipt, including those grievances and appeals relating to PROVIDER physicians, PROVIDER non-physician providers or the care rendered thereby.

Member Grievances. (a) Stage 1 (b) Stage 2 (i) the nature of the grievance; (ii) the facts upon which the grievance is based; (iii) the remedy sought; (iv) the result of the informal stage; and (v) the article(s) of this agreement relied upon or claimed to have been violated, misinterpreted or improperly applied. (c) Stage 3

Member Grievances. 2.7.1. The Provider shall address all clinical concerns of the Member as related to the clinical services provided to the Member pursuant to this Agreement. Provider shall refer any unresolved concerns or requests to Sandhills Center. In accordance with 10A N.C.A.C. 27G.0201(a)(18), the Provider shall have in place a written policy for its Grievance Process and procedures for review and disposition of client grievances. The process shall be accessible to all Members and must be operated in a fair and impartial fashion. 2.7.2. Sandhills Center may receive grievances directly that may involve Provider. If such a grievance is received by Sandhills Center, Sandhills Center will follow the State regulations and rules regarding the investigation and/or mediation of said grievance. Provider shall cooperate with all investigative requests as required by Controlling Authority. Failure to cooperate is a material breach of this Agreement and grounds for termination. 2.7.3. Sandhills Center will maintain documentation on all follow-up and findings of any investigation. Provider will be provided a written summary of Sandhills Center’s findings upon completion of the investigation. 2.7.4. If any issues are cited as out of compliance with this Agreement or Controlling Authority, the Provider may be required by Sandhills Center to document and implement a plan of correction. The Provider will maintain a system to receive and respond timely to grievances received regarding the Provider, including documentation to include, at a minimum, date received, points of grievance, resolution/follow-up provided and the date grievance was resolved.

Member Grievances. Oxford shall use its Best Efforts to ensure that Oxford Par Providers cooperate and abide by the Oxford Covered Member Complaint and Grievance System in resolving any Oxford Covered Member grievances related to the provision of services provided pursuant to this Agreement. Oxford shall notify PA HRM of all Oxford Covered Member complaints brought to the attention of Oxford and/or Oxford Par Providers. Oxford shall notify PA HRM promptly of any action taken or proposed with respect to the resolution of such complaints and the avoidance of similar complaints in the future.

Member Grievances. If you are dissatisfied with medical treatment you have received, you should discuss the problem with your Provider. If the problem is not resolved at that level, or if the dissatisfaction concerns another matter, you should contact Us, either orally or in writing to obtain information on Our Grievance procedures or to file a Grievance with Us. You have the right to designate a representative (e.g. your Physician) to file a Grievance and, if the Grievance decision is adverse to you, an Appeal, with Us on your behalf and to represent you in a Grievance or an Appeal. If a Provider files a Grievance with Us that qualifies for Expedited Review, the Provider will be deemed to be your representative and correspondence concerning the Grievance will be sent directly to the Provider. In all other situations in which a representative seeks a Grievance or an Appeal on your behalf, We must obtain a signed Designation of Representation form from you before We can deal directly with your representative. We will forward a Designation of Representation form to you for completion. If We do not obtain a signed Designation of Representation form, We will continue to research your Grievance but will respond only to you unless a Designation of Representation form is received. We will accept oral or written comments, documents or other information relating to the Grievance from the Member or the Member’s Provider by telephone, facsimile or other reasonable means. Members are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Member’s Appeal. To obtain information on Our Grievance procedures or to file a Grievance orally with Us, please call the toll free customer service number listed on the back of your Plan Identification Card. A Plan representative who is knowledgeable about Our Grievance procedures and any applicable state laws and regulations will be available to assist you at least 40 normal business hours per week. You can also call Us at ▇-▇▇▇-▇▇▇-▇▇▇▇ at any time to leave a voice mail message concerning a Grievance. Any messages you leave through this toll-free number will be returned on the following business day by a qualified Plan representative. We will also accept Grievances filed in writing, including by facsimile. If you wish to file your Grievance in writing, please mail it to: Anthem Appeals, P.O. Box 105568, Atlanta, GA 30348-5568, ATTN: Appeals Specialist. O...

Member Grievances. At all stages of this process, a member of the faculty may consult with a representative of the Association. The member may, upon request to the Association, be accompanied by an Association representative to any discussion, formal or informal, of the matter in question. Step 1: When reason arises to question the action of an administrator, the member of the faculty ordinarily shall discuss the matter with that administrator. The matter may be resolved at this point by mutual consent; but if an adjustment does not result, the member shall have the option of informally discussing the matter with the respective ▇▇▇▇ or Vice President for Academic Affairs. Step 2: If no satisfactory adjustment is reached, the member shall, within thirty

Member Grievances. UBH maintains a procedure for processing and resolving Member grievances as required by Louisiana law. Provider has been notified that Member grievances may be submitted by telephone or in writing to the appropriate telephone number and address provided to Provider.