Grievance and Appeals System definition

Grievance and Appeals System means an overall system that includes a Grievance process, an Appeal process, and access to the Medicaid State’s fair hearing system.
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Grievance and Appeals System means the overall system that includes Grievances and Appeals handled at the MCO and access to the State Fair Hearing process.
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Grievance and Appeals System means the process the Contractor implements to handle Appeals of an Adverse Benefit Determination, Grievances, as well as the process 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
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Examples of Grievance and Appeals System in a sentence

  • The Division Director of Human Resources will be responsible for the development, implementation, management, and administration of an Employee Grievance and Appeals System (EGAS) applicable to all covered employees of the South Carolina Department of Corrections (SCDC).

  • Activity 1 description: PCS-MP will improve the Grievance and Appeals System by working with NEMT subcontractors to initiate interventions to ensure timely member pick-up.

  • Activity 1 description: PCS-LN will improve the Grievance and Appeals System by working with NEMT subcontractors to initiate interventions to ensure timely member pick-up.

  • The Grievance System Coordinator ensures our Member Grievance and Appeals System is responsive to the needs of our members.

  • The policy is inconsistent with APL 17-006, state regulation, and the Plan’s Contract.” The Plan’s policy and procedure, PS-CR07, Member Grievance and Appeals System, stated, “Receipt and Resolution of a Provider Complaint: a.) The Provider Services Department is charged with the resolution of provider complaints.

  • Please see Appendix A.11 for the policy and procedure regarding GHC-SCW’s Member Grievance and Appeals System.

  • Plan policy G&A-001 Grievance and Appeals System Description contained a check list that included sending acknowledgment and resolution letters in the member’s preferred language.

  • The policy, "Member Grievance and Appeals System Description," states that if Home State Health fails to adhere to the notice and timing requirements under section 2.12.16 c(22) of the MHD contract, the member is deemed to have exhausted Home State Health's internal level of appeal and may initiate a State Fair Hearing.

  • Code Regs., Title 28, §1300.68(a)(4)(d)(2)) Plan policy G&A-001 Grievance and Appeals System Description (revised 1/21/20) stated the Plan would ensure each issue is addressed and resolved when a complainant presents with multiple issues.

  • These procedures are detailed in Member Services Policy andProcedure MS-23 Member Appeals, MS-24 Communication and Education of Grievance and Appeals Process and MS-25 Monitoring and Oversight of Grievance and Appeals System.


More Definitions of Grievance and Appeals System

Grievance and Appeals System means the process the Contractor implements to handle Appeals of an Adverse Benefit Determination, Grievances, as well as the process to collect and track information about them. Health Care-Acquired Condition or HAC means a condition occurring in any inpatient hospital setting, defined as a HAC by the Secretary of Health and Human Services under Section 1886(d)(4)(D)(iv) of the Social Security Act for purposes of the Medicare program identified in the State Plan as described in Section 1886(D)(4)(D)(ii) and (iv) of the Act; other than Deep Vein Thrombosis(DVT)/Pulmonary Embolism (PE) as related to total knee replacement or hip replacement surgery in pediatric and obstetric patients.
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Grievance and Appeals System means means the process the Contractor implements to handle Appeals of an Adverse Benefit Determination, Grievances, as well as the process 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 (1) through payments to, or arrangements with, providers; (2) under a Comprehensive Risk Contract with the State; and (3) meets the following criteria: (i) first became operational prior to January 1, 1986; or (ii) is described in section 9517(c)(3) of the Omnibus Budget Reconciliation Act of 1985 (as amended by section 4734 of the Omnibus Budget Reconciliation Act of 1990 and section 205 of the Medicare Improvements for Patients and Providers Act of 2008).
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Grievance and Appeals System means an overall system that includes a Grievance process, an Appeal process, and access to the Medicaid State’s fair hearing system. Health Insuring Organization (HIO) means a county operated entity, that in exchange for capitation payments, covers services for beneficiaries (1) through payments to, or arrangements with, providers; (2) under a comprehensive risk contract with the State; and (3) meets the following criteria: (i) first became operational prior to January 1, 1986; or (ii) is described in section 9517(c)(3) of the Omnibus Budget Reconciliation Act of 1985 (as amended by section 4734 of the Omnibus Budget Reconciliation Act of 1990 and section 205 of the Medicare Improvements for Patients and Providers Act of 2008).
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Related to Grievance and Appeals System

  • 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.

  • 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.

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

  • Municipal Separate Storm Sewer System Management Program means a management program covering the duration of a state permit for a municipal separate storm sewer system that includes a comprehensive planning process that involves public participation and intergovernmental coordination, to reduce the discharge of pollutants to the maximum extent practicable, to protect water quality, and to satisfy the appropriate water quality requirements of the CWA and regulations, and this article and its attendant regulations, using management practices, control techniques, and system, design, and engineering methods, and such other provisions that are appropriate.

  • 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.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • 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;

  • 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.

  • 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.

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

  • 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.

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

  • Data Protection Impact Assessment means an assessment by the Controller of the impact of the envisaged processing on the protection of Personal Data.

  • Public safety answering point or “PSAP” means an answering location for 911 calls originating in a given area. The E911 Customer may designate a PSAP as primary or secondary, which refers to the order in which calls are directed for answering. Primary PSAPs answer calls; secondary PSAPs receive calls on a transfer basis. PSAPs are public safety agencies such as police, fire, emergency medical, etc., or a common bureau serving a group of such entities.

  • Environmental and Social Management Plan or “ESMP” means a site-specific environmental and social management plan to be prepared in accordance with the parameters laid down in the ESMF and acceptable to the Association, setting forth a set of mitigation, monitoring, and institutional measures to be taken during the implementation and operation of the Project activities to eliminate adverse environmental and social impacts, offset them, or reduce them to acceptable levels, and including the actions needed to implement these measures.

  • Local Mental Health Authority means a county legislative body.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Quality Assurance Plan or “QAP” shall have the meaning set forth in Clause 11.2;

  • Unfit-for-use tank system means a tank system that has been determined through an integrity assessment or other inspection to be no longer capable of storing or treating hazardous waste without posing a threat of release of hazardous waste to the environment.

  • Status with regard to public assistance means the condition of being a recipient of federal, state, or local assistance, including medical assistance, or of being a tenant receiving federal, state, or local subsidies, including rental assistance or rent supplements.

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

  • Public safety answering point (PSAP) means a 24-hour, state, local, or contracted communications facility, which has been designated by the local service board to receive 911 service calls and dispatch emergency response services in accordance with the E911 service plan.

  • Claims Administration means the processing of claims made under the Shared Policies, including the reporting of claims to the insurance carriers, management and defense of claims and providing for appropriate releases upon settlement of claims.