Common use of NOTICE TO ENROLLEE PROCEDURES Clause in Contracts

NOTICE TO ENROLLEE PROCEDURES. Upon receipt of the following type of complaints; 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO shall send a notice to the Enrollee. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. APPENDIX F October 1, 2004 F-3 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment and description of the complaint prepared by the MCO. The acknowledgment must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.

NOTICE TO ENROLLEE PROCEDURES. Upon receipt of the following type of complaints; 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO MCO) shall send a notice to the Enrollee. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. APPENDIX F October 1, 2004 F-3 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment and description of the complaint prepared by the MCO. The acknowledgment must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.

NOTICE TO ENROLLEE PROCEDURES. Upon receipt of the following type of complaints; 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO shall send a notice to the Enrollee. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. APPENDIX F October 1, 2004 F-3F- 3 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment and description of the complaint prepared by the MCO. The acknowledgment must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.

NOTICE TO ENROLLEE PROCEDURES. Upon receipt of the following type of complaints; 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO shall send a notice to the Enrollee. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. APPENDIX F October 1, 2004 F-32004 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment and description of the complaint prepared by the MCO. The acknowledgment must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.

NOTICE TO ENROLLEE PROCEDURES. Upon The MCO shall send a notice to the Enrollee upon receipt of the following type types of complaints; complaints anytime the MCO: 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO shall send a notice to the EnrolleeBenefit Package. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. FHPlus APPENDIX F October 1, 2004 2001 F-3 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which the Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment and description of the complaint prepared by the MCO. The acknowledgment must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.

NOTICE TO ENROLLEE PROCEDURES. Upon receipt of the following type of complaints; 1) anytime that the MCO denies access to a referral; 2) denies or reduces benefits or services; 3) determines that a requested benefit is not covered by the MCO's benefit package, the MCO shall send a notice to the Enrollee. The notice shall describe: a) The Enrollee's right to file a complaint regarding any dispute with the MCO. b) The information to be provided to the MCO in order for a determination to be made. APPENDIX F October 1, 2004 F-3 c) The fact that the MCO will not retaliate or take any discriminatory action against the Enrollee because he/she filed a complaint or appeal. d) The the right of the Enrollee to designate a representative to file complaints and appeals on his/her behalf. e) The MCO's requirements for accepting written complaints, which can be either a letter or MCO supplied form. f) The Enrollee's right to file a verbal complaint when the dispute is about referrals or covered benefits. The MCO must list a toll-free number which Enrollee may use to file a verbal complaint. g) For verbal complaints, whether the Enrollee is required to sign an acknowledgment acknowledgement and description of the complaint prepared by the MCO. The acknowledgment acknowledgement must clearly advise the Enrollee that the Enrollee may amend the description but must sign and return it in order to initiate the complaint.