Grievance and Appeal System means the processes the Contractor implements to handle Appeals of an Adverse Benefit Determination and Grievances, as well as the processes to collect and track information about them. Health Insuring Organization (HIO) means a county operated entity that in exchange for Capitation Payments, covers services for beneficiaries:
Grievance and Appeal System means the processes the MCO or DBM must implement in accordance with 42 C.F.R. Part 438, Subpart F, to handle enrollee grievances and appeals, as well as the processes to collect and track information about them.
Grievance and Appeal System means the processes a BHO implements to handle appeals of adverse benefit determinations and grievances as well as the processes to collect and track information about them. The BHO must establish the grievance and appeal system and meet the requirements of 42 C.F.R. Sec. 438, Subpart F (2017).
Examples of Grievance and Appeal System in a sentence
The Contractor must provide reports on the Grievance and Appeal System as required in the AHCCCS Grievance and Appeal System Reporting Guide available on the AHCCCS website.
Member Grievance and Appeal System For all cites in Section 9.1 through Section 9.1.1.3.2, please refer to the contract for all requirements.
The Contractor shall provide the following information regarding the Grievance and Appeal System for GFS/FBG funded Contracted Services to all Subcontractors: The toll-free numbers to file oral Grievances and Appeals.
Continue to be available to advocate and assist the Individual through the Grievance and Appeal System and Administrative Hearing processes, including participating in face to face meetings with Behavioral Health agency representatives at the Individual’s request.
The Contractor shall also ensure that it timely provides written information to both enrollees and providers, which clearly explains the Grievance and Appeal System requirements.
More Definitions of Grievance and Appeal System
Grievance and Appeal System means the processes the MCO imple- ments to handle appeals of adverse benefit determinations and grievan- ces, as well as the processes to collect and track information about them.
Grievance and Appeal System means the overall system that includes Grievances and Appeals handled by the Contractor and access to the Administrative Hearing system.
Grievance and Appeal System means the processes the PAHP implements to handle appeals of an adverse benefit determination and grievances, as well as the processes to collect and track information about them.
Grievance and Appeal System means a comprehensive system that includes a grievance process, an appeal process, and access to the Commonwealth’s fair hearing system. Health Care Effectiveness Data and Information Set (HEDIS™) means a national performance improvement tool developed by the National Committee for Quality Assurance (NCQA) and used to measure performance across six domains of care. Health Information means any Health Information provided and/or made available by the Department to a Trading Partner, and has the same meaning as the term “Health Information” as defined by 45 C.F.R. Part 160.103. Health Insurance Portability and Accountability Act (HIPAA) of 1996, and the implementing regulations (45 C.F. R. Sections 142, 160, 162, and 164), all as may be amended. Health Maintenance Organization (HMO) is a licensed entity in the Commonwealth pursuant to KRS 304.38, et seq. Health Risk Assessment (HRA) refers to a standardized screening tool used by the Department’s contracted MCOs to collect information on an Enrollee’s health status, including mental health and substance use disorders(s). Additionally, other information that is collected includes, but is not limited to Enrollee demographics, personal and family medical history, and lifestyle. The Contractor shall use the assessment to identify need for health, behavioral health or community services and to determine when to conduct a more comprehensive Enrollee Needs Assessment to identify Enrollees who are in need of care management. HHS Transaction Standard Regulation means 45 C.F.R., at Title 45, Parts 160 and 162, as may be amended.
Grievance and Appeal System means the processes the Contractor implements to handle appeals of Adverse Benefit Determinations and Grievances, as well as the processes to collect and track information about them. (42 C.F.R. § 438.400 to § 438.424).
Grievance and Appeal System has the meaning provided for “Grievance System” in OAR 410-141-3500.
Grievance and Appeal System means the processes a Behavioral Health Organization (BHO) implements to handle appeals of adverse benefit determinations and grievances as well as the processes to collect and track information about them. The BHO must establish the grievance and appeal system and meet the requirements of 42 CFR § 438 Subpart F.