Grievance Administration Sample Clauses

The Grievance Administration clause outlines the procedures and responsibilities for handling complaints or disputes within an organization or between parties to an agreement. Typically, it specifies the steps for submitting a grievance, the timelines for response, and the roles of various individuals or committees involved in resolving the issue. By establishing a clear process for addressing grievances, this clause helps ensure that concerns are managed fairly and efficiently, reducing the risk of unresolved conflicts and promoting a harmonious working environment.
Grievance Administration. Internal (plan level) Grievance An Enrollee may file an Internal Enrollee Grievance at any time with the One Care Plan or its providers by calling or writing to the Contractor or provider. The Contractor must have a system in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the Americans with Disabilities Act. The Contractor must maintain written records of all Grievance activities, and notify CMS and EOHHS of all internal Grievances. The system must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance; Timely review of each Enrollee Grievance; Response, electronically, orally or in writing, to each Enrollee Grievance within a reasonable time, but no later than thirty (30) days after the Contractor receives the Grievance; The Contractor may extend the thirty (30) day timeframe for processing a Grievance by up to fourteen (14) calendar days if the Enrollee requests the extension or if the Contractor shows there is a need for additional information and how the delay is in the interest of the Enrollee. If the Contractor extends the timeframe for a Grievance and it is not at the Enrollee’s request, the Contractor must make reasonable efforts to give the Enrollee prompt oral Notice of the delay. In addition, within two (2) days the Contractor must give the Enrollee written Notice of the reason for the extended timeframe and inform the Enrollee of the right to file a Grievance if he or she disagrees with that decision. Expedited response, orally or in writing, within twenty‑four (24) hours after the Contractor receives the Grievance to each Enrollee Grievance whenever Contractor extends the Appeals timeframe or Contractor refuses to grant a request for an expedited Appeal; Provides notice to the Enrollee of the disposition of the Grievance meets the requirements of 42 C.F.R § 438.10 and: Be produced in a manner, format, and language that can be easily understood; Be made available in Prevalent Languages, upon request; and Include information, in the most commonly used languages about how to request translation services and Alternative Formats; and The availability to Enrollees of information about Enrollee Grievances and Appeals, as described here and in Section 2.12, including reasonable assistance in completing any forms or other procedural steps, which shall include interpreter services and toll‑free numbers with TTY/TDD and interpreter capabil...
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Grievance Administration. Internal (plan level) Grievance An Enrollee may file an Internal Enrollee Grievance at any time with the ICO or its providers by calling or writing to the Contractor or provider. The Contractor must have a system in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the Americans with Disabilities Act. The Contractor must maintain written records of all Grievance activities, and notify CMS and MassHealth of all internal Grievances. The system must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance; Timely review of each Enrollee Grievance; Response, electronically, orally or in writing, to each Enrollee Grievance within a reasonable time, but no later than 30 days after the Contractor receives the Grievance; Expedited response, orally or in writing, within 24 hours after the Contractor receives the Grievance to each Enrollee Grievance whenever Contractor extends the Appeals timeframe or Contractor refuses to grant a request for an expedited Appeal; and Availability to Enrollees of information about Enrollee Appeals, as described in Section 2.12, including reasonable assistance in completing any forms or other procedural steps, which shall include interpreter services and toll-free numbers with TTY/TDD and interpreter capability. 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. 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 Contract Management Team and entered into the CMS Complaints tracking module, which will be accessible to the Contractor.
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Grievance Administration. Pension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Grievance Administration. The CICO must have a formally structured Grievance system, consistent with 42 C.F.R. § 438 Subpart F, and the SCDHHS Managed Care Policies and Procedures Guide (▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇.▇▇▇/managedcare/site-page/mco-contract-pp), in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the ADA. The CICO Grievance procedures must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance;
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Grievance Administration. Time spent in processing or representing grievances but only to the extent authorized in Section G. of Article 9,
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Grievance Administration. Internal (plan level) Grievance An Enrollee may file an Internal Enrollee Grievance at any time with the ICO or its providers by calling or writing to the Contractor or provider. The Contractor must have a system in place for addressing Enrollee Grievances, including Grievances regarding reasonable accommodations and access to services under the Americans with Disabilities Act. The Contractor must maintain written records of all Grievance activities, and notify CMS and MassHealth of all internal Grievances. The system must meet the following standards: Timely acknowledgement of receipt of each Enrollee Grievance;
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Grievance Administration. The central parties agree to develop a pilot project to assist the local parties with innovative and creative solutions to enhance grievance administration, such project could include regional review of grievances, regional mediation and/or regional panels of arbitrators. The parties will canvass their respective parties to elicit interest in participation in the project. practices of the Hospitals. The parties agree that from time to time they will endorse best practices that demonstrate creative joint quality of initiatives.
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Grievance Administration. 2.13.2.1. Internal (plan level) Grievance
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Grievance Administration 
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Related to Grievance Administration

  • Reinsurance Administration A. Within thirty (30) days after the end of each calendar month, the Cedent shall take all reasonable and appropriate steps to furnish the Reinsurer with a seriatim electronic report, as detailed in Schedule C, for each Reinsured Contract, valued as of the last day of that month. On or before September 30, 2001, the Cedent shall provide the initial seriatim electronic report, which shall cover the period from the Effective Date hereof through August 31, 2001; provided, however, that the initial seriatim electronic report may omit Funding Vehicle Values by MorningStar designation. The Cedent shall provide complete seriatim electronic data, as required herein, on or before April 30, 2002. Failure to provide this information as required shall constitute a material breach within the scope of Article XX, Paragraph G. B. Additionally, within thirty (30) days after the end of each calendar month the Cedent shall furnish the Reinsurer with a separate Summary Statement containing the following: 1. Reinsurance Premiums due to the Reinsurer summarized separately for each premium class by GMDB, EPB, and Income Program, as shown in Exhibit II; 2. benefit claim recoverables due to the Cedent in total and, if applicable, broken down by VNAR, SCNAR, and EEMNAR and Income Program; and 3. the month end date for the period covered by the Summary Statement. C. If the net balance is due to the Reinsurer, the Cedent shall remit the amount due with the Summary Statement, but no later than thirty (30) days after the month end date for the period covered by the Summary Statement. If the net balance is due to the Cedent, the Reinsurer shall remit the amount due to the Cedent within ten (10) days after receipt of the Summary Statement. D. The payment of Reinsurance Premiums is a condition precedent to the liability of the Reinsurer under this Agreement. In the event that the Cedent does not pay the Reinsurance Premiums in a timely manner, as defined below, the Reinsurer may exercise the following rights: 1. The Reinsurer shall charge interest if Reinsurance Premiums are not paid within thirty (30) days of the due date, as defined in Paragraph C of this Article. The interest rate charged shall be based on the ninety-(90) day federal Treasury ▇▇▇▇, as published in The Wall Street Journal on the first business day in the month following the due date of the Reinsurance Premiums, plus one hundred (100) basis points. The method of calculation shall be simple interest (360-day year). 2. The Reinsurer may terminate this Agreement in the event that Reinsurance Premium payments are more than sixty (60) days past due after the due date, as described in Paragraph C of this Article, by giving sixty (60) day written notice of termination to the Cedent. As of the close of the last day of this sixty-(60) day notice period, the Reinsurer's liability with respect to the ceded liabilities shall terminate. If all Reinsurance Premiums that are the subject of a sixty (60) day termination notice shall have been received by the Reinsurer within the time specified, the termination notice shall be deemed vacated and the Agreement shall remain in effect.

  • Program Administration An activity relating to the general management, oversight and coordination of community development programs. Costs directly related to carrying out eligible activities are not included.

  • 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.

  • Policy Administration The Company shall provide all required, necessary and appropriate claims, administrative and other services with respect to the Policies. The Company shall use reasonable care in its administration and claims practices with respect to the Policies and in administering and performing its duties under this Agreement and such practices, administration and performance shall (a) conform with Applicable Law; (b) not be fraudulent; and (c) be no less favorable than those used by the Company with respect to other policies of the Company not reinsured by the Reinsurer.

  • Claims Administration An employee will be required to comply with any and all rules and regulations and/or limitations established by the carrier or applicable third party administrator and contained in the policy, and employees and their dependents shall look solely to such carrier or third party administration for the adjudication of the payment of any and all benefits claims.