Common use of Provider Grievances and Appeals Clause in Contracts

Provider Grievances and Appeals. The Contractor shall implement a process to ensure that a Provider shall have the right to file an internal appeal with the Contractor regarding denial of a health care service or claim for reimbursement, provider payment or contractual issues. The Department shall provide a standard Provider Grievance Form to be used by the Contractor to initiate its provider grievance process. Appeals received from Providers that are on the Member’s behalf for denied services with requisite consent of the Member are deemed Member appeals and not subject to this Section.

Provider Grievances and Appeals. The Contractor shall implement a process to ensure that a Provider shall have the right to file an internal appeal with the Contractor regarding denial of a health care service or claim for reimbursement, provider payment or contractual issues. The Department shall provide a standard Provider Grievance Form to be used by the Contractor to initiate its provider grievance process. Appeals received from Providers that are on the Member’s behalf for denied services with requisite consent of the Member are deemed Member appeals and not subject to this Section.. Contractor shall log Provider appeals. Appeals shall be recorded in a