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2nd Level Formal Appeal Sample Clauses

2nd Level Formal Appeal. If a 1st Level Formal Appeal is not resolved to the Insured’s satisfaction, an Insured may then file a 2nd
Sample 1Sample 2
2nd Level Formal Appeal. When a 1st Level Formal Appeal is not resolved in a manner that is satisfactory to the Insured, the Insured may initiate a 2nd Level Formal Appeal. This appeal must be submitted orally or in writing within thirty (30) days after the Insured has been informed of the resolution of the 1st Level Formal Appeal.
Sample 1Sample 2
2nd Level Formal Appeal. When a 1st Level Formal Appeal is not resolved in a manner that is satisfactory to the Insured, the Insured may initiate a 2nd Level Formal Appeal. This appeal must be submitted in writing within thirty (30) days after the Insured has been informed of the resolution of the 1st Level Formal Appeal. Exhaustion of the 1st Level Formal Appeal procedure is a precondition to filing a 2nd Level Formal Appeal. A 2nd Level Formal Appeal not filed in a timely manner will be deemed waived with respect to the Adverse Benefit Determination to which it relates. The 2nd Level Formal Appeal is voluntary for all Pre-Service, Post-Service, and Urgent Care Claims for Benefits. Adverse determinations eligible for Expedited 2nd Level Formal Appeals set forth in this section are only those relating to Pre-Service Claims related to Medical Necessity, appropriateness of service, healthcare service, healthcare setting, or level of care or effectiveness of a healthcare service. The Insured has forty-eight (48) hours to request an Expedited 2nd Level Formal Appeal from the date of the notification of the Adverse Determination. Expedited 2nd Level Formal Appeals must be decided no later than seventy-two (72) hours after receipt of the Expedited 2nd Level Formal Appeal, provided all necessary information has been submitted to SHL. If the initial notification was oral, SHL shall provide a written or electronic explanation to the Insured seventy-two (72) hours after the expedited appeal being filed.
Sample 1
2nd Level Formal Appeal. When a 1st Level Formal Appeal is not resolved in a manner that is satisfactory to the Insured, the Insured may initiate a 2nd Level Formal Appeal. This appeal must be submitted orally or in writing within thirty (30) days after the Insured has been informed of the resolution of the 1st Level Formal Appeal. Exhaustion of the 1st Level Formal Appeal procedure is a precondition to filing a 2nd Level Formal Appeal. A 2nd Level Formal Appeal not filed in a timely manner will be deemed waived with respect to the Adverse Benefit Determination to which it relates. The 2nd Level Formal Appeal is voluntary for all Pre-Service and Post-Service Claims for Benefits. Expedited appeals are not eligible for 2nd Level Formal Appeal. Expedited appeals may be processed through the Expedited External Review process. Please reference Expedited External Review of this plan document. The notice to the Insured or the Insured’s Authorized Representative will also include • a HIPAA compliant authorization for use by which the Insured or Insured’s Authorized Representative can authorize SHL and the Insured’s Physician to disclose protected health information (”PHI”), including medical records, that are pertinent to the 2nd Level Formal appeal and • any other forms as required by Nevada law or regulation. The 2nd Level Formal Appeal review cannot be scheduled without the written authorization from the Insured or the Insured’s Authorized Representative. The Insured shall be entitled to the same reasonable access to copies of documents referenced above under the 1st Level Formal Appeal. Any new or additional information considered, relied upon or generated by the Plan will be provided to the Insured, free of charge and in advance of the date on which the notice of the final internal adverse determination is required, in order to give the Insured a reasonable opportunity to respond prior to this date. The Insured can request the assistance of a Member Services Representative at any time during this process. Upon request, the Insured is entitled to present telephonically and provide a formal presentation on a 2nd Level Formal Appeal. If such a hearing is requested, SHL shall make every reasonable effort to schedule a mutually convenient time for the parties involved. Repeated refusal on the part of the Insured to cooperate in the scheduling of the formal presentation shall relieve the Grievance Review Committee of the responsibility of hearing a formal presentation, but not of reviewing...
Sample 1
2nd Level Formal Appeal. When a 1st Level Formal Appeal is not resolved in a manner that is satisfactory to the Member, the Member may initiate a 2nd Level Formal Appeal. This appeal must be submitted orally or in writing within thirty (30) days after the Member has been informed of the resolution of the 1st Level Formal Appeal. Exhaustion of the 1st Level Formal Appeal procedure is a precondition to filing a 2nd Level Formal Appeal. A 2nd Level Formal Appeal not filed in a timely manner will be deemed waived with respect to the Adverse Benefit Determination to which it relates. The 2nd Level Formal Appeal is voluntary for all Pre-Service and Post-Service Claims for Benefits. Expedited appeals are not eligible for 2nd Level Formal Appeal. Expedited appeals may be processed through the Expedited External Review process. Please reference Expedited External Review of this plan document. The notice to the Member or the Member’s Authorized Representative will also include • a HIPAA compliant authorization form by which the Member or the Member’s Authorized Representative can authorize HPN and the Member’s Physician to disclose protected health information (“PHI”), including medical records, that are pertinent to the 2nd Level Formal Appeal and • any other forms as required by Nevada law or regulation.
Sample 1
2nd Level Formal Appeal. If a 1st Level Formal Appeal is not resolved to the Member’s satisfaction, a Member may then file a 2nd Level Formal Appeal. A 2nd Level Formal Appeal is submitted either orally or in writing and reviewed by the Grievance Review Committee. The 2nd Level Formal Appeal is voluntary for all Adverse Benefit Determinations. Appeals that meet expedite criteria are not eligible for 2nd Level Formal Appeal and may be processed through the Expedited External Review process.
Sample 1

Related to 2nd Level Formal Appeal

  • Formal Level A. Level I: 1. Within five (5) work days of the oral response, if the grievance is not resolved, it shall be stated in writing on the "Academic Grievance" form as provided by the District (and shown as Exhibit "A" of this Agreement), signed by the grievant (or Federation Representative), and presented to his/her supervisor (or designee) at the xxxx level or above. 2. The supervisor or designee shall communicate his/her decision to the unit member in writing within five (5) days after receiving the grievance. 3. Within the above time limits, either the grievant (or Federation Representative) or the immediate supervisor (or designee) may request a personal conference with the other party. B. Level II: 1. In the event the grievant is not satisfied with the decision at Level I, he/she may appeal the decision on the appropriate form to the college/campus president, or his/her designee, within five (5) days. 2. This statement shall include a copy of the original grievance and a written copy of the decision rendered by the unit member's supervisor or designee. 3. The college/campus president, or his/her designee, shall communicate the decision to the grievant in writing within seven (7) days of receiving the appeal. Either the grievant (or Federation Representative) or the college/campus president (or his/her designee) may request a personal conference within the above time limits. C. Level III 1. If the grievant is not satisfied with the decision at Level II, he/she may within five (5) days appeal the decision on the appropriate form to the Chancellor, or his/her designee. 2. This statement shall include copies of the original grievance and appeal and written copies of the decisions rendered. 3. The Chancellor, or his/her designee, shall communicate his/her decision in writing to the grievant within fifteen (15) days. D. Level IV--Advisory Arbitration 1. Within fifteen (15) work days after receipt of the decision of the Chancellor, the Federation may, upon written notice to the Associate Vice Chancellor, Human Resources, submit the grievance to arbitration under and in accordance with the prevailing rules of the California State Mediation and Conciliation Services. Only the Federation (exclusive representative) may demand arbitration.

  • Senior Level Negotiations If after fifteen (15) Days of receipt of the Dispute Notice Response by the submitting party or, in the event that the receiving party fails to timely submit a Dispute Notice Response, either Party may, by providing written Notice to the other party, request that the Dispute be resolved by direct negotiations between senior level negotiators of the parties (“Senior Level Negotiations Notice”). It is within each party’s discretion to determine who constitutes a senior level negotiator, and this person may be, among other possibilities, a senior executive or in-house counsel. The senior level negotiators shall confer as often as they deem reasonably necessary to exchange information and attempt to resolve the Dispute within thirty (30) Days after the Senior Level Negotiations Notice is given to the other party.

  • Staffing Levels To the extent legislative appropriations and PIN authorizations allow, safe staffing levels will be maintained in all institutions where employees have patient, client, inmate or student care responsibilities. In July of each year, the Secretary or Deputy Secretary of each agency will, upon request, meet with the Union, to hear the employees’ views regarding staffing levels. In August of each year, the Secretary or Deputy Secretary of Budget and Management will, upon request, meet with the Union to hear the employees’ views regarding the Governor’s budget request.

  • Long Term Cost Evaluation Criterion # 4 READ CAREFULLY and see in the RFP document under "Proposal Scoring and Evaluation". Points will be assigned to this criterion based on your answer to this Attribute. Points are awarded if you agree not i ncrease your catalog prices (as defined herein) more than X% annually over the previous year for years two and thr ee and potentially year four, unless an exigent circumstance exists in the marketplace and the excess price increase which exceeds X% annually is supported by documentation provided by you and your suppliers and shared with TIP S, if requested. If you agree NOT to increase prices more than 5%, except when justified by supporting documentati on, you are awarded 10 points; if 6% to 14%, except when justified by supporting documentation, you receive 1 to 9 points incrementally. Price increases 14% or greater, except when justified by supporting documentation, receive 0 points. increases will be 5% or less annually per question Required Confidentiality Claim Form This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from th e “Attachments” section, complete according to the instructions on the form, then uploading the completed form, wit h any confidential attachments, if applicable, to the “Response Attachments” section titled “Confidentiality Form” in order to provide to TIPS the completed form titled, “CONFIDENTIALITY CLAIM FORM”. By completing this process, you provide us with the information we require to comply with the open record laws of the State of Texas as they ma y apply to your proposal submission. If you do not provide the form with your proposal, an award will not be made if your proposal is qualified for an award, until TIPS has an accurate, completed form from you. Read the form carefully before completing and if you have any questions, email Xxxx Xxxxxx at TIPS at xxxx.xxxxxx@t xxx-xxx.xxx

  • Work Plan [Procuring Entity shall provide main features of the work plan that the Tenderer should provide in the tender for carrying out the contract, from beginning to the end].

  • Formal Grievance Step 1 6

  • Change in Scope of Work Any change in the scope of the Work, method of performance, nature of materials or price thereof, or any other matter materially affecting the performance or nature of the Work shall not be paid for or accepted unless such change, addition, or deletion is approved in advance and in writing by a valid change order executed by the District. Contractor specifically understands, acknowledges, and agrees that the District shall have the right to request any alterations, deviations, reductions, or additions to the Project or Work, and the cost thereof shall be added to or deducted from the amount of the Contract Price by fair and reasonable valuations. Contractor also agrees to provide the District with all information requested to substantiate the cost of the change order and to inform the District whether the Work will be done by the Contractor or a subcontractor. In addition to any other information requested, Contractor shall submit, prior to approval of the change order, its request for a time extension (if any), as well as all information necessary to substantiate its belief that such change will delay the completion of the Work. If Contractor fails to submit its request for a time extension or the necessary supporting information, it shall be deemed to have waived its right to request such extension.

  • Formal Grievance Procedure 1. In the event that a complaint cannot be resolved informally, the parties shall pursue the first step in the formal grievance procedure before making any application for arbitration, unless the College and the AAUP agree in writing to alter the procedure or waive one or more of the steps by proceeding directly to arbitration. 2. Upon written request of the AAUP Contract Compliance Officer, the College shall submit any requested documents in its possession which may be necessary for investigation of the grievance. The College shall deliver such documents as soon as is reasonably possible, but no later than seven (7) days after receipt of a written request. 3. Internal Steps in the Procedure a. Step One: The Director of Human Resources (1) Within thirty (30) days of when the AAUP learns of, or in the exercise of reasonable diligence should have learned of, an alleged violation of the provisions of this Agreement, the AAUP shall submit to the Director of Human Resources a completed Faculty Grievance Form or a dated, signed, written description of the grievance, clearly labeled "grievance" containing substantially the same information as provided for on the Faculty Grievance Form. (2) Within eight (8) days of receipt of the written grievance, the Director of Human Resources shall convene a meeting to discuss the grievance. Such meeting shall include the grievant(s) and/or the designated representative(s) of the AAUP and shall be scheduled at a time which is mutually convenient to the parties. (3) The Director of Human Resources shall attempt to determine the facts pertaining to the grievance and shall notify the grievant and the AAUP in writing of his/her decision within eight (8) days in a Grievance Disposition Form or in a document containing substantially the same information as contained in a Grievance Disposition Form, which shall include written details of the reasons which support the decision. (4) Within eight (8) days after receipt of the disposition of the Director of Human Resources, the AAUP may appeal the decision in writing to the College Grievance Officer, by submitting a Grievance Disposition Reaction Form or a document containing substantially the same information as contained in a Grievance Disposition Reaction Form. (5) By agreement, the parties may decide to advance the grievance to step two of the procedure, or to appeal directly to arbitration at step D(4) of this article.

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • Review Process Limitations The Asset Representations Reviewer will have no obligation (i) to determine whether a Delinquency Trigger Event has occurred or whether the required percentage of Noteholders has voted to direct an Asset Representations Review under the Indenture, (ii) to determine which Receivables are subject to an Asset Representations Review, (iii) to obtain or confirm the validity of the Review Materials, (iv) to obtain missing or insufficient Review Materials except as specifically described herein, (v) to take any action or cause any other party to take any action under any of the Transaction Documents to enforce any remedies for breaches of representations or warranties about the Eligible Representations, (vi) to determine the reason for the delinquency of any Review Receivable, the creditworthiness of any Obligor, the overall quality of any Review Receivable or the compliance by the Servicer with its covenants with respect to the servicing of such Review Receivable, or (vii) to establish cause, materiality or recourse for any failed Test as described in Section 3.03.

Most Referenced Clauses

Most Referenced Definitions