Grievance and Appeals Process definition

Grievance and Appeals Process means the formal process described in the Benefit Plan and/or in the Provider Manual for the submission of Grievances or requesting review of denials of coverage or utilization review decisions. This process provides for expedited review, which may be requested over the phone, in cases where the State Health Plan Member’s health would be detrimentally affected by a delay of care pending the standard review process.
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Examples of Grievance and Appeals Process in a sentence

  • If your request to obtain a Second Opinion is denied and you would like to appeal ADP’s decision, please refer to ADP’s Grievance and Appeals Process in this Supplement.

  • Refer respectively to Sections VI: Required Benefits, and Section XIX-B: Inquiry, Grievance, and Appeals Process.

  • Subgrantees must make accommodations for clients who have language or disability barriers that would prevent them from participating in the appeals process.See Appendix 3: Shelter Network Grievance and Appeals Process for additional information on the termination and grievance policies and procedures.

  • If the student is still not satisfied, he/she may submit an appeal to AU by following the AU Student Academic Grievance and Appeals Process.

  • The Trustee shall treat the Basis Risk Reserve Fund as an outside reserve fund within the meaning of Treasury Regulation 1.860G-2(h) that is owned by the Class X Certificateholder and 103 that is not an asset of the REMIC.

  • Below are Molina Healthcare’s Member Grievance and Appeals Process.

  • Should MSHN fail to pay or adequately provide for such additional payment to PROVIDER within the thirty (30) days following receipt of notification from PROVIDER, PROVIDER shall have the right and process of appeal as set forth in the Grievance and Appeals Process defined in the MSHN- SUDSP Manual.

  • Client Grievance and Appeals Process This procedure has been established by Chugachmiut to assist clients in resolving any complaints or grievances arising from any real or perceived violations of clients’ rights.

  • The Graduate School does not intervene in grade disputes, though suspensions and dismissals from affiliated programs can be appealed to the Graduate School (see "Academic Grievance and Appeals Process" on the Graduate School website).

  • The timeframe for resolution is ninety (90) calendar days from receipt of the grievance as provided in Rhode Island Medicaid Managed Care Grievance and Appeals Process.

Related to Grievance and Appeals Process

  • Claims Process means the process for Settlement Class Members’ submission of Claims, as described in Section III.

  • Complaints Procedure means the School's procedure for handling complaints from parents, as amended from time to time for legal or other substantive reasons, or in order to assist the proper administration of the School. It does not form part of the contract between you and the School. A copy of the most up-to-date procedure is on the School's website and is otherwise available from the School at any time upon request;

  • Grievance Procedure is used in this Agreement, it shall be considered as including the arbitration procedure.

  • Grievance means a complaint in writing that an employee, group of employees, or the Union submits to management, to be processed through the grievance procedure.

  • Statement of Grievance shall name the grievant(s) involved, the facts giving rise to the grievance, the provision(s) of the Agreement alleged to be violated, and the remedy (specific relief) requested.

  • Grievance System means the overall system that includes:

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Service Complaints For service problems you should contact your local utility by calling: Vectren Energy Delivery at 800.227.1376. IF YOU SMELL GAS PLEASE MOVE TO A SAFE AREA AND CALL 911 OR YOUR LOCAL UTILITY. Authorization/Representation/Letter of Agency:By entering into this Agreement, you authorize XOOM to act on your behalf under your local utility’s tariffs in accordance with the rules and regulations of the PUCO. You acknowledge that you are the local utility account holder, or a person legally authorized to execute this Agreement on behalf of the account holder for natural gas services and that you are at least eighteen (18) years of age. You agree to authorize XOOM to obtain your credit information and you agree to authorize your local utility to release all information relating to your historical and current natural gas usage, billing and payment history to XOOM or its authorized representatives. You further acknowledge that XOOM has full authority to make all rates and tariff selections necessary to meet its obligations under this Agreement. You may rescind this authorization at any time by contacting XOOM. Neither your social security number, customer account number nor any other customer financial information will be released by XOOM, except where such release is required by court order or by Commission Order or Rule, without your affirmative written consent. Execution of this Agreement shall constitute authorization for the release of this information to XOOM.

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • A grievance means a dispute or disagreement as to the interpretation or application of terms and conditions of employment contained in this Agreement.

  • Grievance Committee means the Grievance Committee of the Bar.

  • Mobile crisis outreach team means a crisis intervention service for minors or families of minors experiencing behavioral health or psychiatric emergencies.

  • Project Management Report means each report prepared in accordance with Section 4.02 of this Agreement;

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Grievances filed under this Article shall begin at Step 2. Grievances under this clause shall be handled with all possible confidentiality and dispatch.

  • Complaints means each of the following documents:

  • Quality improvement organization or “QIO” shall mean the organization that performs medical peer review of Medicaid claims, including review of validity of hospital diagnosis and procedure coding information; completeness, adequacy and quality of care; appropriateness of admission, discharge and transfer; and appropriateness of prospective payment outlier cases. These activities undertaken by the QIO may be included in a contractual relationship with the Iowa Medicaid enterprise.

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Appeals Tribunal or “AT” means the Body responsible for hearing and determining appeals set out in section 9;

  • Expedited Appeal means if a Member appeals a decision regarding a denied request for Prior Authorization (Pre-Service Claim) for an Urgent Care Claim, the Member or Member’s Authorized Representative can request an Expedited Appeal, either orally or in writing. Decisions regarding an Expedited Appeal are generally made within seventy-two (72) hours from the Plan’s receipt of the request.

  • Personal Grievance means a claim that an employee: (a) Has been unjustifiably dismissed; or (b) has had his/her employment, or his/her conditions of employment, affected to (c) his/her disadvantage by some unjustifiable action by the employer; or (d) has been discriminated against in his/her employment; or (e) has been sexually harassed in his/her employment; or (f) has been racially harassed in his/her employment; or (g) has been subjected to duress in relation to union membership.

  • Expedited review means an examination, in accordance with

  • LOCKHEED XXXXXX Procurement Representative means a person authorized by LOCKHEED XXXXXX'x cognizant procurement organization to administer and/or execute this Contract.

  • Adverse System Impact means a negative effect that compromises the safety or reliability of the electric distribution system or materially affects the quality of electric service provided by the electric distribution company (EDC) to other customers.

  • Multidisciplinary team means a group of individuals who possess knowledge and skills related to the diagnosis, assessment, and disposition of child abuse cases and who are professionals practicing in the disciplines of medicine, nursing, public health, substance abuse, domestic violence, mental health, social work, child development, education, law, juvenile probation, or law enforcement, or a group established pursuant to section 235B.1, subsection 1.

  • Claims processing services means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include: