Provider Grievance and Appeals. The CONTRACTOR shall establish and maintain written policies and procedures for the filing of provider grievances and appeals. A provider shall have the right to file a grievance or an appeal with the CONTRACTOR. Provider grievances or appeals shall be resolved within thirty (30) calendar days. If the provider grievance or appeal is not resolved within thirty (30) calendar days, the CONTRACTOR shall request a fourteen (14) day extension from the provider. If the provider requests the extension, the extension shall be approved by the CONTRACTOR. A provider shall have the right to file an appeal with the CONTRACTOR regarding provider payment issues and/or utilization management decisions.
Provider Grievance and Appeals. The SE shall establish and maintain written policies and procedures for the filing of provider grievances and appeals. A provider shall have the right to file a grievance or an appeal with the SE. Provider grievances or appeals shall be resolved within thirty (30) calendar days. If the provider grievance or appeal is not resolved within thirty (30) calendar days, the SE shall request a fourteen (14) day extension from the provider. If the provider requests the extension, the extension shall be approved by the SE. A provider shall have the right to file an appeal with the SE regarding provider payment issues and/or utilization management decisions. Following the conclusion of this grievance and appeal process, providers may contact the Collaborative CEO.
