External Grievance Clause Samples

The External Grievance clause establishes a formal process for parties to raise and resolve complaints or disputes through an independent, third-party mechanism outside the organization. Typically, this clause outlines the steps for submitting a grievance, the criteria for external review, and the timelines for resolution, often involving mediation or arbitration by a neutral body. Its core function is to provide an impartial avenue for addressing issues that cannot be resolved internally, thereby promoting fairness and transparency in dispute resolution.
External Grievance. The Contractor shall inform Enrollees that they may file an external Grievance through 1‑800 Medicare. The Contractor must display a link to the electronic Grievance form on the ▇▇▇▇▇▇▇▇.▇▇▇ Internet Web site on the Contractor’s main Web page as required by 42 C.F.R. § 422.504(b)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll‑free telephone number where an Enrollee Grievance may be filed. External Grievances filed with MassHealth shall be forwarded to the CMT and entered into the CMS Complaints tracking module, which will be accessible to the Contractor.
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External Grievance. The Contractor shall inform Enrollees that they may file an external Grievance through 1-800 Medicare. The Contractor must display a link to the electronic Grievance form on the ▇▇▇▇▇▇▇▇.▇▇▇ Internet Web site on the Contractor‘s main Web page as required by 42 C.F.R. § 422.504(b)(15)(ii). The Contractor must inform Enrollees of the email address, postal address or toll-free telephone number where an Enrollee Grievance may be filed. External Grievances filed with MassHealth shall be forwarded to the CMT and entered into the CMS Enrollee Appeals Complaints tracking module, which will be accessible to the Contractor. All Contractors shall utilize and all Enrollees may access the existing Medicare Part D Appeals Process, as described in Appendix F. Consistent with existing rules, Part D Appeals will be automatically forwarded to the IRE if the Contractor misses the applicable adjudication timeframe. The Contractor must maintain written records of all Appeal activities, and notify CMS and MassHealth of all internal Appeals. Integrated/Unified Non-Part D Appeals Process Overview: 2.12.1.2.1. Notice of Action – In accordance with 42 C.F.R. § 438.404 and 42 C.F.R. §§ 422.568-572, the Contractor must give the Enrollee written notice of any Adverse Benefit Determination. Such notice shall be provided at least ten (10) days in advance of the date of its action, in accordance with 42 C.F.R. § 438.404. An Enrollee or a provider acting on behalf of an Enrollee and with the Enrollee‘s written consent may Appeal the Contractor‘s decision to deny, terminate, suspend, or reduce services. In accordance with 42 C.F.R. § 438.402 and 42 C.F.R. § 422.574, an Enrollee or provider action on behalf of an Enrollee and with the Enrollee‘s consent may also Appeal the Contractor‘s delay in providing or arranging for a Covered Service. Appeal time frames - As more fully detailed below, Enrollees, and/or their providers, or their authorized Appeal representatives will have sixty (60) days to file an Appeal related to coverage and benefits. The Contractor shall acknowledge receipt of each Appeal and notify EOHHS of Board of Hearings Appeals daily. Appeal levels Initial Appeals (first level internal Appeal) will be filed with the Contractor. Subsequent Appeals for traditional Medicare A and B services will be automatically forwarded to the Medicare Independent Review Entity (IRE) by the Contractor. Subsequent Appeals for services covered by MassHealth only (e.g. Personal Assistance Service...
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External Grievance. A Participant may file an external grievance through the process outlined in the Three-way Contract.
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External Grievance. If Our decision under the Appeals process is not satisfactory to you, you may qualify to request an External Grievance. To qualify for an External Grievance all of the following requirements must be met:
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External Grievance 
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Related to External Grievance

  • Group Grievance Where a number of employees have identical grievances and each employee would be entitled to grieve separately they may present a group grievance in writing signed by each employee who is grieving to the Administrator or her designate within ten (10) days after the circumstances giving rise to the grievance have occurred or ought reasonably to have come to the attention of the employee(s). The grievance shall then be treated as being initiated at Step No. 1 and the applicable provisions of this Article shall then apply with respect to the processing of such grievance.

  • Policy Grievance – Union Grievance The Union may institute a grievance alleging a general misinterpretation or violation of this Agreement by the Employer by submitting a written grievance at Step No. 1 within twenty (20) days after the circumstances have occurred. This section shall not apply to disciplinary grievances or application of competitive clauses under this Agreement.

  • Grievance A grievance is an alleged violation, misinterpretation, or misapplication of the terms of the negotiated agreement between the Board and the Association.

  • Informal Grievance 1. Within fourteen (14) calendar days of the event giving rise to a grievance, the grievant shall present the grievance informally for disposition by the immediate supervisor or at any appropriate level of authority within the department. 2. Presentation of an informal grievance shall be a prerequisite to the institution of a formal grievance.

  • Policy Grievance Where either Party disputes the general application, interpretation or alleged violation of an article of this Agreement, the dispute shall be discussed initially with the Employer or the Union, as the case may be, within thirty (30) days of the occurrence. Where no satisfactory agreement is reached, either Party may submit the dispute to arbitration, as set out in Article 10.