Urgent grievance definition

Urgent grievance means a grievance where using the standard timeframe of the grievance process would: (a) seriously jeopardize the life or health of a member; or (b) would jeopardize the member’s ability to regain maximum function.
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Urgent grievance a request for a Health Service that, if subject to the time limits applicable to Post-service Grievances or Pre-Service Grievances would do either of the following.
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Urgent grievance means an adverse determination when the stan- dard timeframe of the grievance procedure would seriously jeopardize the life or health of a subscriber or would jeopardize the subscriber’s ability to regain maximum function.
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Examples of Urgent grievance in a sentence

  • If You are not satisfied with a decision We made either before or after You have filed a Grievance and Your situation meets the requirements of an Urgent Grievance, You have the right to use this Urgent Care procedure.

  • For Urgent Grievance Appeals, a health care practitioner with knowledge of Your condition may act as Your representative.

  • We will decide Your Urgent Grievance as soon as possible, but no later than 72 hours after the receipt of the initial request for the Urgent Grievance.

  • We will treat Your Urgent Grievance pursuant to the procedure described in Section 8.2 and Section 8.4, except that We will shorten the time limits as follows.

  • We will acknowledge Your Urgent Grievance within 24 hours (and include any request for additional information, if appropriate).

  • Once identified as such, an Urgent Grievance will be subject to only one review before becoming eligible for the External Appeal process described in Section 8.6. Your Urgent Grievance may be expressed to Us orally or in writing and should set forth all issues, comments, or other documented evidence that support it.


More Definitions of Urgent grievance

Urgent grievance means an adverse determination when the standard time frame of the grievance procedure would seriously jeopardize the dental health of a member or would jeopardize the member’s ability to regain maximum function. Vendor – an individual or entity that engages in the business of selling care, goods, services, or commodities. Violation - each determination by the Agency that a PDHP failed to act as specified in the contract or in applicable statutes or rules governing Medicaid PDHPs. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required dental services or items to beneficiaries is considered for purposes of this contract to be a separate violation. 110.0 EXHIBITS‌ 110.1 FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES‌ Section 381.026, F.S.
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Urgent grievance an adverse determination when the standard timeframe of the grievance procedure would seriously jeopardize the life or health of an enrollee, or the enrollee's ability to regain maximum function. Violation - each determination by the department and/or agency that a contractor failed to act as specified in the contract or in applicable statutes or rules governing Medicaid prepaid health plans. Each day that an ongoing violation continues may be considered for the purposes of this contract to be a separate violation. In addition, each instance of failing to furnish necessary and/or required services or items to enrollees is considered for purposes of this contract to be a separate violation. Attachment I- 7 of 55 Contract No. 0000-0000-00 LONG-TERM CARE COMMUNITY DIVERSION PILOT PROJECT REQUIREMENTS SECTION GENERAL CONTRACT REQUIREMENTS CONTRACTOR QUALIFICATIONS To qualify as a long-term care community diversion program contractor, the contractor must: A. Have a certificate of authority from the Florida Department of Insurance to operate as a health maintenance organization (HMO) pursuant to Chapter 641 Part I, Florida Statutes, and have a health care provider certificate from the Agency for Health Care Administration (agency) pursuant to Chapter 641.49, Florida Statutes, for those counties in the service area in which the applicant will apply to provide services or; B. Have a license issued pursuant to Chapter 400, Florida Statutes, and meet the provisions of an "other qualified provider" set forth in Section 430.703(7), Florida Statutes, including satisfying all financial and quality assurance requirements for a provider service network as specified in Section 409.912, Florida Statutes, and; C. Have, or have a subcontractor that has, prior experience in providing home and community-based long-term care services in the project service area and; D. Have the capacity to integrate the delivery of acute and long-term care services to enrollees; and E. Meet all the requirements to enroll as a Medicaid prepaid health services provider; and F. Meet all other requirements in the remaining provisions of this contract and its attachments.
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Urgent grievance. A written complaint from a member expressing dissatisfaction with: o Any request to reconsider as adverse initial determination (denial of service) o Written appeal to a previous determination of a urgent complaint that, if left unresponded to, has the potential to become an emergency. All grievances triaged as "urgent" will be fully responded to within 48 hours of APSH PR notification of the complaint. PROCEDURE:
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Related to Urgent grievance

  • 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.

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

  • 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.

  • 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.

  • 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.

  • Plagiarism means to take and present as one's own a material portion of the ideas or words of another or to present as one's own an idea or work derived from an existing source without full and proper credit to the source of the ideas, words, or works. Plagiarism includes, but is not limited to:

  • Complaint means any dissatisfaction expressed by a Complainant orally or in writing to HMO about any aspect of HMO’s operation, including, but not limited to:

  • Urgent Work means any urgent measures which in the opinion of Engineer-in-charge become necessary during the progress of the work to obviate any risk of accident or failure or disruption of generation which become necessary for security.

  • 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.

  • Urgent medical condition means a condition that satisfies either of the following: