Member Grievance definition

Member Grievance. A Member grievance is a claim by a Member, who is solely affected, that the terms and conditions of this agreement have been violated, misapplied or misinterpreted.
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Member Grievance means an expression of dissatisfaction from a Member, responsible party, advocate, etc., with any aspect of a Member's care other than an adverse benefit determination.
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Member Grievance procedure, as specified in Section 6.9, Member Services/Grievance System.
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Examples of Member Grievance in a sentence

  • Grievances will be deemed to have been filed on the date received by AvMed, and will be processed through AvMed’s formal Member Grievance Procedures.

  • The report template can be found at https://msp.scdhhs.gov/managedcare/site-page/excel-report-templates Section 9.1: Member Grievance Log: Grievance reporting required of the MCO.

  • The appropriate communications and outreach and education processes, such as the Manage Applicant and Member Communication, Perform Population and Member Outreach, and Manage Member Grievance and Appeal business process for follow up with the affected parties, including informing parties of their procedural rights (Note: This may precede or follow termination procedures)Enrollment brokers may perform some of the steps in this process.

  • Member Grievance ProcedureMembers are encouraged to attempt to resolve any issues or grievances with the participating dentist without initiating a grievance with DentaQuest.

  • Issues, not specifically clarified in the contract, shall be settled with mutual consent between the PSA and the Bank, without vitiating the basic premises of the contract.

  • GCM - Grievance Committee Member Grievance - Any alleged violation, maladministration, misadministration, or non-administration, where applicable, of the Agreement.

  • Finally, the health plan shall ensure that the health plan’s employees, subcontractors, providers, and members meet all requirements outlined in the Fraud, Waste, and Abuse and Program Integrity Policies, Operational Data Reporting, Encounter Data and Transactions, Member Grievance System, and Provider Complaints and Appeals sections of the contract.

  • Procedures for If You prefer to file a formal Grievance, You may do so by requesting aFiling a Grievance Member Grievance form from Us by calling the telephone number on Your ID card, and submitting the form to Us. In order to request a first level Grievance, Your request must be filed within three hundred sixty- five (365) days from the date: (a) You received notice of an Adverse Determination made pursuant to Utilization Review, or (b) for Post- Service Claims, You received the Explanation of Benefits.

  • All Medicare member liability denials are subject to the Medicare Complaints, Appeals and Grievances (MCAG) process as outlined in the Medicare Member Liability Appeals and Medicare Member Grievance sections of this Provider Manual.

  • For more information see KHS Policy and Procedure: 5.01-P KHS Member Grievance Process Member Report of Complaint/GrievanceMembers are encouraged but not required to submit their grievance in writing using the Member Report of Complaint/Grievance form.


More Definitions of Member Grievance

Member Grievance means an oral or written expression of dissatisfaction, including any complaint, dispute, request for reconsideration or appeal made by a Member. CDHS considers complaints and appeals the same as a grievance.
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Related to Member Grievance

  • Grievance means a dispute arising out of the interpretation, application, administration or alleged violation of the terms of this Agreement.

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

  • 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.

  • Policy Grievance is defined as a difference between the parties relating to the interpretation, application or administration of this Agreement. A policy grievance may be submitted by either party at Step 2 of the grievance procedure. A policy grievance shall be signed by a CLAC Representative and submitted to the Employer. A policy grievance submitted by the Employer shall be signed by the Employer or his representative.

  • Grievance Committee means the Grievance Committee of the Bar.

  • Grievant means an employee or group of employees having the same grievance. In the case of a group of employees, one employee shall be designated by the group to act as spokesperson and to be responsible for processing the grievance.

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

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

  • Grievance System means the overall system that includes:

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

  • Member Company means a “service recipient” as defined in Treasury Regulation § 1.409A-1(h)(3).

  • 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;

  • Network Operating Committee means a group made up of representatives from the Network Customer(s) and the Transmission Provider established to coordinate operating criteria and other technical considerations required for implementation of Network Integration Transmission Service under Tariff, Part III.

  • Member means a member of the Board;

  • Labor dispute as used here, means a strike, lockout, or other labor dispute between the Employer and its Employees, during which time the Employee is not paid by the Employer.

  • Disciplinary Committee means any person or committee of persons, or any subcommittee thereof, that is author- ized by a self-regulatory organization to issue disciplinary charges, to con- duct disciplinary proceedings, to settle disciplinary charges, to impose dis- ciplinary sanctions or to hear appeals thereof.

  • Multidisciplinary team means a membership of individuals who possess knowledge and skills related to the diagnosis, assessment, and disposition of dependent adult abuse cases and who are professionals practicing in the disciplines of medicine, public health, social work, law, law enforcement and other disciplines relative to dependent adults. Members of the team shall include, but are not limited to, persons representing the area agencies on aging, county attorneys, health care providers, and others involved in advocating or providing services for dependent adults.

  • Personal Grievance means a claim of unjustifiable dismissal, unjustifiable disadvantage, discrimination, sexual or racial harassment, or duress in relation to membership or non-membership of a union or employees’ organisation.

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

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner 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.

  • Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who has 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.

  • Qualified mental health professional means a licensed medical practitioner or any other person meeting the qualifications specified in OAR 309-019-0125.

  • 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.

  • Grievor means the employee concerned, a local of the Union, the Union or the Company.

  • Investigating Committee means any Officer/Committee appointed by Competent Authority to conduct investigation.