ENROLLEE GRIEVANCES Sample Clauses

ENROLLEE GRIEVANCES a. The CONTRACTOR shall address all clinical concerns of the Enrollee as related to the clinical services provided to the Enrollee pursuant to this contract. CONTRACTOR shall refer any unresolved concerns or requests for LME/PIHP services or provider change to the LME/PIHP. The CONTRACTOR shall have in place a Complaint and Grievance Process that is documented in written policy or procedures, and shall ensure that said process is accessible to all Enrollees and that said process operates in a fair and impartial fashion. b. The LME/PIHP may receive complaints directly, which involve the CONTRACTOR. If a complaint is received by the LME/PIHP, State rules/regulations regarding the investigation and/or mediation of complaints will be followed. Based on the nature of the complaint, the LME/PIHP may choose to investigate the complaint, as authorized by Controlling Authority, in order to determine its validity. CONTRACTOR will be required to cooperate fully with all investigative requests as required by Controlling Authority. c. The LME/PIHP will maintain documentation on all follow up and findings of any complaint investigation. The CONTRACTOR will be provided a written summary of the LME/PIHP’s findings. d. During an investigation, if any issues are cited as out of compliance with this Contract or Controlling Authority, the CONTRACTOR may be required to document and implement a plan of correction as required by Controlling Authority. The CONTRACTOR will maintain a system to receive and respond timely to complaints received regarding the CONTRACTOR. The CONTRACTOR will maintain documentation on the complaint to include, at a minimum, date received, points of complaint, resolution/follow up provided, and date complaint resolved.
ENROLLEE GRIEVANCES. The LME/PIHP’s Anonymous Concern and Complaint line must be published and made available to Enrollees and family members.
ENROLLEE GRIEVANCES. Physician Group agrees to cooperate with Health Plan in resolving Enrollee grievances related to Physician Group or Group Providers. Health Plan will bring to the Physician Group’s attention all Enrollee grievances involving Group Providers, and Physician Group will investigate such grievances and use its best efforts to resolve them in a fair and equitable manner. Physician Group agrees to notify Health Plan promptly of any action taken or proposed with respect to the resolution of such grievances and the avoidance of similar grievances in the future. Physician Group’s failure to resolve a grievance through its established procedures could result in the application of Health Plan’s grievance procedures or procedures required by HCFA.
ENROLLEE GRIEVANCES. THP or the Payor, as determined by the terms of the Master Agreement, shall have primary and final responsibility for administering Enrollee grievance procedures.
ENROLLEE GRIEVANCES. TBH shall have primary and final responsibility for administering Enrollee grievance procedures. Provider shall be given notice of and the right to participate in any Enrollee grievance procedure.
ENROLLEE GRIEVANCES. The Contractor shall submit supplemented call scripts to the Department for review:
ENROLLEE GRIEVANCES. ‌ The PCC shall assist in Grievance resolution procedures as follows: A. If an Enrollee has a Grievance related to the PCC, the PCC shall work cooperatively with the Enrollee and EOHHS to resolve the Grievance. B. If the Enrollee wishes to file a Grievance, the PCC shall instruct the Enrollee to contact the MassHealth Customer Service Center.

Related to ENROLLEE GRIEVANCES

  • Employee Grievances (a) Grievances on behalf of employees shall be handled as follows:

  • Policy Grievances ‌ Where either party to this agreement disputes the general application, interpretation or alleged violation of an article of this agreement, the dispute shall be discussed initially with the Board of Directors Human Resources Representative (or designate) or the Union within 30 calendar days of the occurrence. Where no satisfactory agreement is reached, either party, within a further 14 calendar days, may submit the dispute to arbitration, as set out in Article 9 of this agreement.

  • Grievances SECTION 1 For the purposes of this Agreement, a grievance shall be defined as: Any complaint by a teacher covered by this Agreement that: (1) the teacher has been subject to a violation, inequitable application, or misinterpretation of a specific provision of this Agreement, or (2) the teacher has been subjected to an unfair or discriminatory act contrary to established policy and practice. SECTION 2 The purpose of this procedure is to secure, at the lowest possible administrative level, equitable solutions to the problems which may from time to time arise affecting the welfare or working conditions of teachers. Both parties agree that these proceedings will be kept as informal and confidential as may be appropriate at any level of this procedure. SECTION 3 Nothing herein contained will be construed as limiting the right of any teacher having a grievance to discuss the matter informally with an appropriate member of the administration and to have the grievance adjusted without intervention of the Association, provided the adjustment is not inconsistent with the terms of this Agreement and that the Association has been given the opportunity to be present at such adjustment above level one and to state its views. If the teacher so chooses, a representative of the Association may be present at level one. The grievant may not elect to have anyone other than the exclusive bargaining representative present or to represent him/her during the grievance/arbitration procedure without the express written consent of the Association. The Association must be notified of the outcome of any level one grievance at which an Association representative is not present. SECTION 4 No written communication, other document, or record relating to any grievance shall be filed in the personnel file maintained by the School Department of the Town of Needham for any teacher involved in presenting such grievance. SECTION 5 Since it is important that grievances be processed as rapidly as possible, the number of days indicated at each level should be considered as maximum, and every effort should be made to expedite the process. For grievances and arbitration time limits, "days" shall be defined as days within the work year for teachers when students are in scheduled classes, including part-days and exam days. The time limits specified may be extended only by mutual agreement. It is understood and agreed that no grievance, dispute, misunderstanding, or difference between the parties arising out of the acts which occurred prior to the execution to this Agreement shall be submitted to the Committee under the provisions of this Article. It is understood that any grievances pending at the conclusion of the contract will remain operative in the subsequent contract period unless settled in negotiations. A teacher may contact the Association at any time prior to or during the grievance procedure. SECTION 6 If at the end of twenty (20) days next following either the occurrence of any grievance or the date when the teacher should reasonably have had first knowledge of its occurrence, whichever is later, the grievance shall not have been presented at Level One, as set forth below, the grievance shall be deemed to have been waived. The Superintendent or designee will respond in writing within ten (10) days of the Level Two meeting. SECTION 7 If there is a grievance which directly affects a group or class of teachers or is of a general nature, the Association may submit such a grievance in writing directly to the level of administration having the appropriate authority to resolve said grievance. SECTION 8 A grievance not initiated within the time specified shall be deemed waived. Failure of the teacher filing the grievance to appeal a decision within the time limit specified will mean that the grievance shall be considered settled on the basis of the decision last made and shall not be eligible for further appeal. Failure of the School Committee to answer an appeal within the time limit specified shall mean that the appeal may be taken to the next step immediately. The above limitations may be waived by mutual agreement of the parties. SECTION 9 In the event a grievance is filed on or after June l which, if left unresolved until the beginning of the following school year could result in irreparable harm to a party in interest, the time limits set forth herein will be reduced so that the grievance procedure may be exhausted prior to the end of the school year or as soon thereafter as is practicable. SECTION 10 The School Committee will, upon request, provide the Association with copies of any documents in its possession including approved minutes of the School Committee which may be necessary for the Association to process grievances under the Agreement.

  • Group Grievances No more than five (5) grievants will be permitted to attend grievance meetings.

  • Policy Grievance – Employer Grievance The Employer may institute a grievance alleging a general misinterpretation or violation by the Union or any employee by filing a written grievance with the Bargaining Unit President, with a copy to the Labour Relations Officer within twenty (20) days after the circumstances have occurred. A meeting will be held between the parties within ten (10) days. The Union shall reply within ten (10) days after the meeting, and failing settlement, the matter may be referred to arbitration. (a) Where a difference arises between the parties relating to the interpretation, application or administration of this Agreement, including any questions as to whether a matter is arbitrable, or where an allegation is made that this Agreement has been violated, either of the parties may, after exhausting the grievance procedure established by this Agreement, notify the other party in writing of its decision to submit the difference or allegation to arbitration, and the notice shall contain the name of the first party's appointee to an Arbitration Board. The recipient of the notice shall, within ten (10) days, inform the other party of the name of its appointee to the Arbitration Board. The two appointees so selected shall within ten (10) days of the appointment of the second of them, appoint a third person who shall be the Chairperson. If the recipient of the notice fails to appoint a nominee, or if the two nominees fail to agree upon a Chairperson within the time limit, the appointment shall be made by the Minister of Labour for Ontario upon the request of either party. (b) Within thirty (30) calendar days of the receipt of notice referred to in Article 8.12(a) above, either party may require a process for a sole arbitrator where the grievance concerns: i) a job posting ii) a short term layoff