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Administrative Review Process Sample Clauses

Administrative Review Process. 4.14.4.1 An Administrative Review is the request for review of a “Proposed Action”. The Member, the Member’s Authorized Xxxxxxxxxxxxxx, X0XX Member or the Provider acting on behalf of the Member with the Member’s written consent, may file an Administrative Review either orally or in writing. Unless the Member, P4HB Member, or Provider requests expedited review, the Member, the Member’s Authorized Xxxxxxxxxxxxxx, X0XX Member or the Provider acting on behalf of the Member with the Member’s written consent, must follow an oral filing with a written, signed, request for Administrative Review. 4.14.4.2 The Member, the Member’s Authorized Xxxxxxxxxxxxxx, X0XX Member or the Provider acting on behalf of the Member with the Member’s written consent, may file an Administrative Review with the Contractor within thirty (30) Calendar Days from the date of the notice of Proposed Action. 4.14.4.3 Administrative Reviews shall be filed directly with the Contractor, or its delegated representatives. The Contractor may delegate this authority to an Administrative Review committee, but the delegation must be in writing. 4.14.4.4 The Contractor shall ensure that the individuals who make decisions on Administrative Reviews are individuals who were not involved in any previous level of review or decision-making; and who are Health Care Professionals who have the appropriate clinical expertise in treating the Member or P4HB Member’s Condition or disease if deciding any of the following: • An Administrative Review of a denial that is based on lack of Medical Necessity. • An Administrative Review that involves clinical issues. 4.14.4.5 The Administrative Review process shall provide the Member, the Member’s Authorized Xxxxxxxxxxxxxx, X0XX Member or the Provider acting on behalf of the Member with the Member’s written consent, a reasonable opportunity to present evidence and allegations of fact or law, in person, as well as in writing. The Contractor shall inform the Member or P4HB Member of the limited time available to provide this in case of expedited review. 4.14.4.6 The Administrative Review process must provide the Member, the Member’s Authorized Xxxxxxxxxxxxxx, X0XX Member or the Provider acting on behalf of the Member with the Member’s written consent, opportunity, before and during the Administrative Review process, to examine the Member or P4HB Member’s case file, including Medical Records, and any other documents and records considered during the Administrative Review pro...
Administrative Review Process. 4.14.4.1 An Administrative Review is the request for review of a "Proposed Action". The Member, the Member's Authorized Representative, or the Provider acting on behalf of the Member with the Member's written consent, may file an Administrative Review either orally or in writing. Unless the Member or Provider requests expedited review, the Member, the Member's Authorized Representative, or the Provider acting on behalf of the Member with the Member's written consent, must follow an oral filing with a written, signed, request for Administrative Review. 4.14.4.2 The Member, the Member's Authorized Representative, or the Provider acting on behalf of the Member with the Member's written consent, may file an Administrative Review with the Contractor within thirty (30) Calendar Days from the date of the notice of Proposed Action. 4.14.4.3 Administrative Reviews shall be filed directly with the Contractor, or its delegated representatives. The Contractor may delegate this authority to an Administrative Review committee, but the delegation must be in writing. 4.14.4.4 The Contractor shall ensure that the individuals who make decisions on Administrative Reviews are individuals who were not involved in any previous level of review or decision-making; and who are Health Care Professionals who have the appropriate clinical expertise in treating the Member's Condition or disease if deciding any of the following: 4.14.4.4.1 An Administrative Review of a denial that is based on lack of Medical Necessity. 4.14.4.4.2 An Administrative Review that involves clinical issues. Revised 5/19/2008 4.14.4.5 The Administrative Review process shall provide the Member, the Member's Authorized Representative, or the Provider acting on behalf of the Member with the Member's written consent, a reasonable opportunity to present evidence and allegations of fact or law, in person, as well as in writing. The Contractor shall inform the Member of the limited time available to provide this in case of expedited review. 4.14.4.6 The Administrative Review process must provide the Member, the Member's Authorized Representative, or the Provider acting on behalf of the Member with the Member's written consent, opportunity, before and during the Administrative Review process, to examine the Member's case file, including Medical Records, and any other documents and records considered during the Administrative Review process. 4.14.4.7 The Administrative Review process must include as parties to the Adm...
Administrative Review Process. 4.14.4.1 An Administrative Review is the request for review of a “Proposed Action”. The Member, the Member’s Authorized Representative, or the Provider acting on behalf of the Member with the Member’s written consent, may file an Administrative Review either orally or in writing. Unless the Member or Provider requests expedited review, the Member, the Member’s Authorized Representative, or the Provider acting on behalf of the Member with the Member’s written consent, must follow an oral filing with a written, signed, request for Administrative Review. 4.14.4.2 The Member, the Member’s Authorized Representative, or the Provider acting on behalf of the Member with the Member’s written consent, may file an Administrative Review with the Contractor within thirty (30) Calendar Days from the date of the notice of Proposed Action. 4.14.4.3 Administrative Reviews shall be filed directly with the Contractor, or its delegated representatives. The Contractor may delegate this authority to an Administrative Review committee, but the delegation must be in writing. 4.14.4.4 The Contractor shall ensure that the individuals who make decisions on Administrative Reviews are individuals who were not involved in any previous level of review or decision-making; and who are Health Care Professionals who have the appropriate clinical expertise in treating the Member’s Condition or disease if deciding any of the following: 4.14.4.4.1 An Administrative Review of a denial that is based on lack of Medical Necessity.
Administrative Review Process. An Adoption Partner who has received a notice that their Adoption Partner privileges have been terminated or restricted, other than a temporary suspension pending investigation, may request a review of DACC's action using the form provided with the notice. The form must be returned to DACC within thirty calendar days and accompanied by a written explanation and any supporting documents that demonstrate why DACC's decision to terminate or restrict an Adoption Partners privilege should be reconsidered. The director or designee will review a decision to terminate or restrict an Adoption Partner's privileges if the request to review satisfies the following criteria:
Administrative Review Process. The onsite AMIDEAST Education Abroad staff, the Country Director (or designee), and AMIDEAST’s Headquarters staff will make use of all available information to determine potential consequences for violating the Student Agreement and Release. Disciplinary action to be taken will be determined during this process. The Student will be notified in writing, as soon as possible, of AMIDEAST’s decision regarding disciplinary actions resulting from the violations of AMIDEAST policies. Any disciplinary actions imposed for violating the Student Agreement and Release are effective immediately. In the case of serious misconduct or for safety concerns, the onsite AMIDEAST Education Abroad staff and Country Director (or designee) has the sole discretion and authority to immediately remove the Student from AMIDEAST facility(s) and/or activity(s), relocate any Student to a different place of residence, or dismiss the Student from the Program. AMIDEAST will notify the Home Institution in advance of any disciplinary action(s) to be taken against a Student.
Administrative Review Process. The Education Abroad staff will make a decision based on the available information regarding the consequences for violating the Student Agreement and Release. Disciplinary action to be taken will be determined during this process. The Student will be notified in writing, as soon as possible, of Amideast’s decision regarding disciplinary actions resulting from the violations of Amideast policies. Any disciplinary actions imposed for violating the Student Agreement and Release are effective immediately. In the case of serious misconduct or for safety concerns, the Amideast Education Abroad staff has the sole discretion and authority to immediately dismiss the Student from the Program. Amideast, at its discretion, may notify the home university of any disciplinary action(s) taken against a Student.

Related to Administrative Review Process

  • Review Process A/E's Work Product will be reviewed by County under its applicable technical requirements and procedures, as follows:

  • Review Procedure If the Plan Administrator denies part or all of the claim, the claimant shall have the opportunity for a full and fair review by the Plan Administrator of the denial, as follows:

  • Procurement Related Complaints and Administrative Review 49.1 The procedures for making a Procurement-related Complaint are as specified in the TDS. 49.2 A request for administrative review shall be made in the form provided under contract forms.

  • Administrative Responsibilities Client shall be responsible for orienting Consultant to Client’s policies and procedures regarding the submission of any requisite paperwork which must be tendered for reimbursement by funding entities such as Medicare, Medicaid, or health insurance. Such paperwork may include, but is not limited to, patient care plans, comprehensive patient histories, individual education plans, or Client specific program plans. During the contracted assignment, should Consultant fail to submit paperwork as required per Client’s policies and procedures, Client must notify ProCare in writing within three (3) business days of alleged failure. Failure to notify ProCare before assignment ends shall negate any Client claim to withhold payment due to untimely work and/or paperwork non-compliance by Consultant. Client agrees that all approved time sheets by Client’s assigned representative are not subjected to billing dispute if Client fails to notify ProCare of time sheet and work performed discrepancies.

  • Asset Representations Review Process Section 3.01 Asset Representations Review Notices and Identification of Review Receivables. On receipt of an Asset Representations Review Notice from the Seller according to Section 5.7 of the Receivables Purchase Agreement, the Asset Representations Reviewer will start an Asset Representations Review. The Servicer will provide the list of Review Receivables to the Asset Representations Reviewer promptly upon receipt of the Asset Representations Review Notice. The Asset Representations Reviewer will not be obligated to start, and will not start, an Asset Representations Review until an Asset Representations Review Notice and the related list of Review Receivables is received. The Asset Representations Reviewer is not obligated to verify (i) whether the conditions to the initiation of the Asset Representations Review and the issuance of an Asset Representations Review Notice described in Section 7.6 of the Indenture were satisfied or (ii) the accuracy or completeness of the list of Review Receivables provided by the Servicer.

  • Claims Review The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.

  • Claims Review Population A description of the Population subject to the Claims Review.

  • AUDIT REVIEW PROCEDURES Any dispute concerning a question of fact arising under an interim or post audit of this AGREEMENT that is not disposed of by agreement, shall be reviewed by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration. Not later than thirty (30) calendar days after issuance of the final audit report, CONSULTANT may request a review by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration of unresolved audit issues. The request for review will be submitted in writing. Neither the pendency of a dispute nor its consideration by ALAMEDA CTC will excuse CONSULTANT from full and timely performance, in accordance with the terms of this AGREEMENT. CONSULTANT and subconsultants’ contracts, including cost proposals and ICRs, may be subject to audits or reviews such as, but not limited to, an AGREEMENT Audit, an Incurred Cost Audit, an ICR Audit, or a certified public accountant (“CPA”) ICR Audit Workpaper Review. If selected for audit or review, the AGREEMENT, cost proposal and ICR and related workpapers, if applicable, will be reviewed to verify compliance with 48 CFR, Chapter 1, Part 31 and other related laws and regulations. In the instances of a CPA ICR Audit Workpaper Review it is CONSULTANT’s responsibility to ensure federal, state, or local government officials are allowed full access to the CPA’s workpapers including making copies as necessary. The AGREEMENT, cost proposal, and ICR shall be adjusted by CONSULTANT and approved by ALAMEDA CTC to conform to the audit or review recommendations. CONSULTANT agrees that individual terms of costs identified in the audit report shall be incorporated into the contract by this reference if directed by ALAMEDA CTC at its sole discretion. Refusal by CONSULTANT to incorporate audit or review recommendations, or to ensure that the federal, state, or local governments have access to CPA workpapers, will be considered a breach of contract terms and cause for termination of the AGREEMENT and disallowance of prior reimbursed costs.

  • Review Protocol A narrative description of how the Claims Review was conducted and what was evaluated.

  • Claims Review Methodology ‌‌ a. C laims Review Population. A description of the Population subject‌‌ to the Quarterly Claims Review.