Appeals Coordinator a staff person designated by the Contractor to act as a liaison between the Contractor and the BOH. Appeal Representative – any individual that the Contractor can document has been authorized by the Enrollee in writing to act on the Enrollee’s behalf with respect to all aspects of a Grievance, Internal Appeal, or BOH Appeal. The Contractor must allow an Enrollee to give a standing authorization to an Appeal Representative to act on his/her behalf for all aspects of Grievances and Internal Appeals. Such standing authorization must be done in writing according to the Contractor’s procedures, and may be revoked by the Enrollee at any time. When a minor is able, under law, to consent to a medical procedure, that minor can request an appeal of the denial of such treatment without parental/guardian consent and appoint an Appeal Representative without the consent of a parent or guardian. ASAM – the American Society for Addiction Medicine, a professional society in the field of addiction medicine that sets standards, guidelines, and performance measures for the delivery of addiction treatment which includes a continuum of five basic levels of care from Level 0.5 (early intervention) to Level 4.0 (medically managed intensive inpatient treatment). References to levels within the Contract with respect to Behavioral Health services are references to these ASAM levels.
Appeals Coordinator a staff person designated by the Contractor to act as a liaison between the Contractor and the BOH. Appeal Representative – any individual that the Contractor can document has been authorized by the Enrollee in writing to act on the Enrollee’s behalf with respect to all aspects of a Grievance, Internal Appeal, or BOH Appeal. The Contractor must allow an Enrollee to give a standing authorization to an Appeal Representative to act on his/her behalf for all aspects of Grievances and Internal Appeals. Such standing authorization must be done in writing according to the Contractor’s procedures, and may be revoked by the Enrollee at any time. When a minor is able, under law, to consent to a medical procedure, that minor can request an appeal of the denial of such treatment without parental/guardian consent and appoint an Appeal Representative without the consent of a parent or guardian. ASAM – a professional society in the field of addiction medicine that sets standards, guidelines, and performance measures for the delivery of addiction treatment which includes a continuum of five basic levels of care from Level 0.5 (early intervention) to Level 4.0 (medically managed intensive inpatient treatment). References to levels within the Contract with respect to Behavioral Health services are references to these ASAM levels.
Appeals Coordinator. A staff person designated by the Contractor to act as a liaison between the Contractor and the Board of Hearings.
