Appeal Determination Sample Clauses

Appeal Determination. In the event that the determination is in your favor, CHA PACE will furnish the disputed service(s) as expeditiously as your health condition requires. If the determination is not fully in your favor, CHA PACE will provide you with written notification of the denial. The notice will include the specific reason(s) for the denial, an explanation of the reason(s) why the service would not improve or maintain your overall health, information about your right to appeal the decision, and a description of your external appeal rights under Medicare or Medicaid.
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Appeal Determination. The Chief Executive Officer will provide written or electronic notice to the Claimant within 90 days after the Chief Executive Officer receives the appeal, unless the Chief Executive Officer determines that any extension of time for processing is required. In the event that the Chief Executive Officer determines that such an extension is required, written notice of the extension will be furnished to the Claimant before the end of the initial 90-day review period. The extension will not exceed a period of 90 days from the end of the initial 90-day period, and the extension notice will indicate the special circumstances requiring such extension of time and the date by which the Chief Executive Officer expects to render the benefit decision. If the Chief Executive Officer denies an appeal in whole or in part (an “Adverse Benefit Determination”) the Chief Executive Officer will set forth, in a manner to be understood by the Claimant:
Appeal Determination. (i) Contractor must perform all services necessary to complete appeals determinations according to Program Requirements and deliver appeals results to Applicant.

Related to Appeal Determination

  • Arbitration Appeal A. If an employee grievance is not resolved at Step 2, the aggrieved employee or the PBA may, within fifteen (15) calendar days after receipt of the Step 2 response, submit a request for arbitration to the Labor Relations Office.

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