Authority to File. The Aggrieved Person may request an expedited Appeal either orally or in writing.
Authority to File i. A beneficiary may file a grievance and request an appeal with the Contractor. A beneficiary may request a state fair hearing after receiving notice under 42 CFR §438.408 that the adverse benefit determination is upheld.
1. In the case that the Contractor fails to adhere to the notice and timing requirements in 42 CFR §438.408, the beneficiary is deemed to have exhausted the Contractor’s appeals process. The beneficiary may initiate a state fair hearing.
Authority to File. Claims may be filed by Customer or its Authorized Agent. Appointment of an Authorized Agent will only be effective upon Boeing's receipt of the Authorized Agent's express written agreement, in a form satisfactory to Boeing, to be bound by and to comply with all applicable terms and conditions of this Aircraft General Terms Agreement.
Authority to File. An Aggrieved Party or an Enrollee’s legally authorized representative may file an Appeal.
Authority to File. The Aggrieved Party may file an expedited Appeal request either orally or in writing. Oral requests for expedited Appeal do not require a follow-up written request.
Authority to File. (A) An Enrollee or the Enrollee’s legally authorized representative may file an Appeal; or
(B) A Provider may file an Appeal.
Authority to File. The Enrollee or a Provider may file an expedited Appeal request either orally or in writing. Oral requests for expedited Appeal do not require a follow-up written request.
Authority to File. All grievances must be filed by or through the Association Business Manager or Agent.
Authority to File i. A beneficiary may file a grievance and request an appeal with the Contractor. A beneficiary may request a state fair hearing after receiving notice under 42 CFR §438.408 that the adverse benefit determination is upheld.
1. In the case that the Contractor fails to adhere to the notice and timing requirements in 42 CFR §438.408, the beneficiary is deemed to have exhausted the Contractor’s appeals process. The beneficiary may initiate a state fair hearing.
2. The Department may offer and arrange for an external medical review if the following conditions are met.
a. The review shall be at the beneficiary’s option and shall not be required before, or used as a deterrent to, proceeding to the state fair hearing.
b. The review shall be independent of both the Department and the Contractor.
c. The review shall be offered without any cost to the beneficiary.
d. The review shall not extend any of the timeframes specified in 42 CFR §438.408 and shall not disrupt the continuation of benefits in 42 CFR §438.420.
ii. With the written consent of the beneficiary, a provider or an authorized representative may request an appeal or file a grievance, or request a state fair hearing, on behalf of a beneficiary, with the exception that providers cannot request continuation of benefits as specified in 42 CFR §438.420(b)(5).
