Provider Grievance Process Sample Clauses

Provider Grievance Process. Contractor may have complaints or grievances, which may arise as a health provider under contract with Plan. These complaints or grievances shall first be addressed through the mechanisms set out in this Section 8.1 (a). There are two basic types of Provider complaints and grievances. The process for resolving complaints and grievances relating to medical or health care delivery issues is outlined in Section 8.1 (a) The process for resolving complaints and grievances relating to other issues, such as payment or administrative issues, is outlined in Section If Contractor is not satisfied with the resolution of such complaints or grievances as outlined in Section 8.1 (a), Contractor shall submit the matter to non- binding mediation as set forth below in Section 8.1 Contractor shall exhaust the both the provider grievance and the mediation procedures before pursuing other available legal remedies.
Sample 1
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Provider Grievance Process. Physician shall have the right to pursue grievances and disputes related to credentialing and re-credentialing, payment determinations, utilization review determinations, quality assurance determinations and sanctions through and in accordance with the grievance process set forth in the Policy and Procedure Manual. Any proposed modifications to the grievance process will be referred to the CCPA Board of Directors for review.
Sample 1
Provider Grievance Process. Contractor acknowledges and agrees to utilize [Provider Organization]’s provider grievance process for the resolution of disputes which may arise between Contractor and [Provider Organization]. A copy of the Provider Grievance process is attached. Governing Law. Contractor shall be subject to applicable provisions of Section 14000 et seq. of Chapter 7, and Section 14590 et seq. of Chapter 8.75, Part 3, Division 9, of the Welfare and Institutions Code, the PACE provider law (P.L. 105-33) and the regulations promulgated thereto (Title 42 of the Code of Federal Regulation, Part 460). Any provision required to be in this Agreement by any of the above laws shall bind Contractor whether or not provided in the Agreement.
Sample 1

Related to Provider Grievance Process

  • Grievance Process In the event of any dispute arising in connection with any part of this clause, such a dispute shall be processed in accordance with the dispute settling provisions of this Agreement.

  • Grievance Processing Union stewards or Union officials shall be permitted to have time off without loss of pay for the investigation and processing of grievances and arbitrations. Requests for such time off shall be made in advance and shall not be unreasonably denied. The Union will furnish the Employer with a list of Union stewards and their jurisdictions. The Union shall delineate the jurisdiction of Union stewards so that no xxxxxxx need travel between work locations or sub-divisions thereof while investigating grievances. Grievants shall be permitted to have time off without loss of pay for processing their grievances through the contractual grievance procedure, except that for class action grievances no more than three (3) grievants shall be granted such leave.

  • CENTRAL GRIEVANCE PROCESS The following process pertains exclusively to grievances on central matters that have been referred to the central process. In accordance with the School Boards Collective Bargaining Act central matters may also be grieved locally, in which case local grievance processes will apply.

  • GRIEVANCE PROCESS RIGHTS No grievant shall lose his/her right to process his/her grievance because of Management-imposed limitations in scheduling meetings.

  • LOCAL GRIEVANCE PROCEDURE 16.1 Any difference between any employee covered by this Agreement and the School Division, or in a proper case between the local of The Association and the School Division concerning the interpretation, application, operation or alleged violation of this Agreement, and further including any dispute as to whether the difference is arbitrable, shall be dealt with as follows, without stoppage of work or refusal to perform work.

  • Grievance Procedure - Party In the case of all other grievances by a party, (including those on behalf of a group of Members, an individual Member, a retired Member or a deceased Member), the party making the grievance may take the following steps in sequence to resolve the matter after the matter has been discussed informally with the other party. The informal discussion shall occur with the Administrator of Employee Relations.

  • Grievance Procedures The AGENCY agrees to establish a formal written grievance process with procedures through which clients and recipients of services may present grievances to the governing authority of the AGENCY regarding services being provided under this Contract. Additionally, the AGENCY agrees to establish fair hearing procedures that ensure all persons will be advised of their rights to a fair hearing to appeal a denial or exclusion from services and/or the failure of staff to take into account the individual’s choice of service. The AGENCY’S internal grievance procedure must document and include, at a minimum, the following: date of grievance, a written response to the applicant sent within thirty (30) days, and the opportunity for the applicant to meet with the AGENCY Executive Director or designee. Upon request by the COUNTY, the AGENCY shall provide a written report as to the grievance outcome within five (5) normal COUNTY working days. The AGENCY will maintain these documents on file for review by the COUNTY.

  • CENTRAL GRIEVANCE PROCEDURE 15.1 Effective until April 30, 2019, this procedure applies to differences:

  • COMPLAINT AND GRIEVANCE PROCEDURE 1. When a member of the bargaining unit has any grievance or complaint, he shall forthwith convey to his immediate superior, orally with or without a member of the Association Executive or in writing, all facts relative to the grievance and/or complaint. The member and the superior shall make every attempt to resolve the problem at this preliminary stage.

  • GRIEVANCE PROCEDURE 7.01 For purposes of this Agreement, a grievance is defined as a difference arising between the parties relating to the interpretation, application, administration or alleged violation of the Agreement including any question as to whether a matter is arbitrable.

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