Examples of Complaint Review Committee in a sentence
The second level internal Complaint Review Committee, consisting of three (3) or more individuals who did not participate in the first level Complaint review and are not directly supervised by any previous decision makers, will review the Complaint.
At least one-third of the second level internal Complaint Review Committee will be individuals who are not employed by the HMO or a related subsidiary or affiliate.
The second level internal Complaint Review Committee will review the Complaint and reach a decision within thirty (30) days and will notify the Member and the Member’s representative if applicable of the decision in writing within five business days.
The First Level Complaint Review Committee shall include one (1) or more employees of the Plan, or its designee, who did not previously participate in a prior decision to deny the Member’s Complaint and shall not be a subordinate of the person(s) who made the adverse benefit determination.
A Member who is dissatisfied with the decision of the First Level Complaint Review Committee may request orally or in writing a voluntary Second Level Complaint Review.