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Appeal Assistance Sample Clauses

Appeal Assistance. If You need Assistance filing an Appeal, You may contact the state independent Consumer Assistance Program at: Community Health Advocates 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxx Xxxx, XX 00000 Or call toll free: 0-000-000-0000, or email xxx@xxxxx.xxx Website: xxx.xxxxxxxxxxxxxxxxxxxxxxxx.xxx
Appeal Assistance. If You need Assistance filing an Appeal, You may contact the state independent Consumer Assistance Program at: Community Health Advocates 000 Xxxxx Xxx., 00xx Xxxxx Xxx Xxxx, XX 00000 Or call toll free: 0-000-000-0000, or email xxx@xxxxx.xxx Website: xxxxxxxxxxxxxxxxxxxxxxxx.xxx SECTION XI - External Appeal A. Your Right to an External Appeal. In some cases, You have a right to an external appeal of a denial of coverage. If We have denied coverage on the basis that a service is not Medically Necessary (including appropriateness, health care setting, level of care or effectiveness of a Covered benefit); or is an experimental or investigational treatment (including clinical trials and treatments for rare diseases), You or Your representative may appeal that decision to an External Appeal Agent, an independent third party certified by the State to conduct these appeals. In order for You to be eligible for an external appeal You must meet the following two (2) requirements: • The service, procedure, or treatment must otherwise be a Covered Service under this Contract; and • In general, You must have received a final adverse determination through Our internal Appeal process. But, You can file an external appeal even though You have not received a final adverse determination through Our internal Appeal process if: o We agree in writing to waive the internal Appeal. We are not required to agree to Your request to waive the internal Appeal; or o You file an external appeal at the same time as You apply for an expedited internal Appeal; or o We fail to adhere to Utilization Review claim processing requirements (other than a minor violation that is not likely to cause prejudice or harm to You, and We demonstrate that the violation was for good cause or due to matters beyond Our control and the violation occurred during an ongoing, good faith exchange of information between You and Us).

Related to Appeal Assistance

  • Legal Assistance The Board shall give full support including legal and other assistance for any assault upon the employee while properly acting in the discharge of his/her duties.

  • Mutual Assistance The Parties will do all things reasonably necessary or appropriate to carry out the terms and provisions of this Agreement and to aid and assist each other in carrying out such terms and provisions.

  • Additional Assistance If you do not understand any of the foregoing Terms and Conditions or if you have any questions or comments, we invite you to contact us at any time. This means you should contact us beforehand if anything of these Terms and Conditions is unclear, unfair or unacceptable to you. Our Commitment to Security and Privacy: To prevent unauthorized access, maintain data accuracy, and ensure the correct use of information, we have put in place the appropriate and reasonable physical, electronic, and managerial procedures to safeguard and secure the information we collect online. Please see our Privacy Policy for further information.

  • Educational Assistance Section 1. Tuition reimbursement shall be provided to employees covered by this collective bargaining AGREEMENT under the same terms and conditions, policies and procedures as the rest of Hennepin County and reflecting a county–wide pool for funding. See Hennepin County Tuition Reimbursement Policy Frequently Asked Questions Section 2. Where courses are required and certified by the appointing authority as essential to current job performance, such appointing authority shall grant 100% reimbursement for tuition, required fees and required study materials. Section 3. At the request of an employee, an Individual Development Plan shall be established. Any employee making the request shall be provided with paid time to work with their Supervisor or Human Resources to develop a training plan for career development within Hennepin County. Human Resources will be a source of career information, and postings, in which the employee may have an interest. Time allotted for this activity and the training plan adopted shall be subject to mutual agreement of the Employee and Supervisor.

  • Financial Assistance Subject to the terms and conditions contained herein, the Director hereby grants to the Recipient financial assistance, as established in this section, for the sole and express purpose of paying or reimbursing the eligible costs certified to the Director under this Agreement for the completion of the Project.

  • Technical Assistance DFPS may provide informal support, guidance, clarification, and other forms of technical assistance via phone, email, and virtual meeting to resolve Grant or performance compliance issues. Grantee will document all such instances of technical assistance by DFPS in writing, including any implementation work.

  • Tuition Assistance Bargaining unit employees can enroll in university or college, vocational technical school or extension courses. The course may be by correspondence or attendance at classes during non-working hours or during working hours with approval of the Agency Head and/or his/her Designee. Where practicable, in relation to work requirements, the Employer shall be liberal with the approval of requests for accrued/unused vacation leave, flex-time scheduling, compensatory time, or leave without pay for the purpose of enabling employees to attend classes conducted during an employee's regularly scheduled work hours.

  • Other Assistance Assist SBEs in their efforts to obtain bonds, lines of credit and insurance. (Note that the Agency has a Surety Bond Program that may assist SBEs in obtaining necessary bonding.) The Agency-Assisted Contractor or Contractor(s) shall require no more stringent bond or insurance standards of SBEs than required of other business enterprises.

  • Audit Assistance Each of the Parties and their respective Subsidiaries are or may be subject to regulation and audit by a Governmental Authority (including a Taxing Authority), standards organizations, customers or other parties to contracts with such Parties or their respective Subsidiaries under applicable Law, standards or contract provisions. If a Governmental Authority, standards organization, customer or other party to a contract with a Party or its Subsidiary exercises its right to examine or audit such Party’s or its Subsidiary’s books, records, documents or accounting practices and procedures pursuant to such applicable Law, standards or contract provisions, and such examination or audit relates to the Services, then the other Party shall provide, at the sole cost and expense of the requesting Party, all assistance reasonably requested by the Party that is subject to the examination or audit in responding to such examination or audits or requests for Information, to the extent that such assistance or Information is within the reasonable control of the cooperating Party and is related to the Services.

  • Employee Assistance Drug and alcohol counseling, rehabilitation, and employee assistance are available from or through the Employer’s employee assistance program provider(s) (E.A.P.).