Common use of Provider Notifications Clause in Contracts

Provider Notifications. A. The Contractor shall inform providers and subcontractors, at the time they enter into a contract, about: 1) Beneficiary grievance, appeal, and State Hearing procedures and timeframes as specified in 42 C.F.R. 438.400 through 42 C.F.R. 438.424. 2) The beneficiary’s right to file grievances and appeals and the requirements and timeframes for filing. 3) The availability of assistance to the beneficiary with filing grievances and appeals. 4) The beneficiary’s right to request a State Hearing after the Contractor has made a determination on a beneficiary's appeal, which is adverse to the beneficiary. 5) The beneficiary’s right to request continuation of benefits that the Contractor seeks to reduce or terminate during an appeal or State Hearing filing, if filed within the allowable timeframes, although the beneficiary may be liable for the cost of any continued benefits while the appeal or State Hearing is pending if the final decision is adverse to the beneficiary.

Provider Notifications. A. The Contractor shall inform providers and subcontractors, at the time they enter into a contract, about: 1) Beneficiary grievance, appeal, and State Hearing fair hearing procedures and timeframes as specified in 42 C.F.R. 438.400 through 42 C.F.R. 438.424. 2) The beneficiary’s right to file grievances and appeals and the requirements and timeframes for filing. 3) The availability of assistance to the beneficiary with filing grievances and appeals. 4) The beneficiary’s right to request a State Hearing fair hearing after the Contractor has made a determination on a beneficiary's appeal, which is adverse to the beneficiary. 5) The beneficiary’s right to request continuation of benefits that the Contractor seeks to reduce or terminate during an appeal or State Hearing state fair hearing filing, if filed within the allowable timeframes, although the beneficiary may be liable for the cost of any continued benefits while the appeal or State Hearing state fair hearing is pending if the final decision is adverse to the beneficiary.