Common use of Quality Concerns and Grievance and Appeals Process Clause in Contracts

Quality Concerns and Grievance and Appeals Process. You agree to notify us of any case that would result in medical care being provided or denied to a State Health Plan Member that you believe to be inappropriate and contrary to accepted professional or ethical standards of medical practice as a result of our administrative or utilization management processes, the availability of the North Carolina State Health Plan Network, or our benefit determinations. You agree to cooperate with and assist State Health Plan Members, and other Practitioners if applicable, in our Grievance and Appeals Process.