Timeframes for Grievance Disposition and Notification. (A) The Contractor shall dispose of each Grievance and provide notice to the affected parties as expeditiously as the Enrollee’s health condition requires, but not to exceed 45 calendar days from the day the Contractor receives the Grievance. (B) For written Grievances, the Contractor shall notify the affected parties in writing of the disposition of the Grievance. For Grievances received orally, the Contractor shall notify the affected parties of the disposition either orally or in writing. (C) If the Enrollee or a Provider files a Grievance with the Department, the Department shall apprise the Enrollee or the Provider, of his or her right to file the Grievance with the Contractor and how to do so. (1) If the Enrollee or Provider prefers, the Department shall promptly notify the Contractor of the Enrollee’s Grievance. (2) If the Contractor receives the Grievance from the Department, the Contractor shall follow the procedures and time frames outlined above for Grievances. (3) If the Contractor receives the Grievance from the Department, the Contractor shall notify the affected parties and the Department, in writing, of the disposition of the Grievance. (D) The Contractor may extend the timeframe for disposing of the Grievance and providing notice by up to 14 calendar days if: (1) the Enrollee requests the extension; or (2) the Contractor shows that there is need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (E) If the Contractor extends the time frame, and the extension was not requested by the Enrollee, the Contractor shall give the Enrollee written notice of the reason for the delay.
Appears in 6 contracts
Samples: Prepaid Mental Health Plan Contract, Chip Dentaquest Amendment 2, Chip Select Health Amendment 1
