§ 438.400 Statutory basis, definitions, and applicability
§ 438.402 General requirements
§ 438.404 Timely and adequate notice of adverse benefit determination
§ 438.406 Handling of grievances and appeals
§ 438.408 Resolution and notification: Grievances and appeals
§ 438.410 Expedited resolution of appeals
§ 438.414 Information about the grievance and appeal system to providers and subcontractors
§ 438.416 Recordkeeping requirements
§ 438.420 Continuation of benefits while the MCO, PIHP, or PAHP appeal and the State fair hearing are pending
§ 438.424 Effectuation of reversed appeal resolutions

Terms Used In CFR > Title 42 > Chapter IV > Subchapter C > Part 438 > Subpart F - Grievance and Appeal System

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.