Claims Turnaround Sample Clauses

Claims Turnaround. The Claims Turnaround is measured as the number of calendar days in which a claims processed to conclusion. The processing of a claim is considered completed on the date that a payment, an Explanation of Benefits form or a denial of claims has been forwarded to the person covered under the Plan or the provider of service. Results are provided quarterly. Penalty is based on an annual average.
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Related to Claims Turnaround

  • Turnaround There shall be a 10 hour rest period between the termination of work on one call and the commencement of work on the next call (see paragraph (f) below for specific rules) and a fifty-four (54) consecutive hour break for a five day week, and a thirty-four (34) consecutive hour break for a six day week.

  • MANAGEMENT GRIEVANCES 8.01 It is understood that the Management may at any time file a grievance with the staff representative of the Union and request a meeting with him to discuss any complaint with respect to the conduct of the Union, its officers or committee member, in its relationships with the Company or other employees or with respect to any complaint that there has been a violation of any contractual obligation undertaken by the Union, and that if such grievance by the Management is not settled to the mutual satisfaction of the conferring parties it may be referred to arbitration as set forth in Article VII above.

  • Technical Objections to Grievances It is the intent of both Parties of this Agreement that no grievance shall be defeated merely because of a technical error, other than time limitations in processing the grievance through the grievance procedure. To this end, an arbitration board shall have the power to allow all necessary amendments to the grievance and the power to waive formal procedural irregularities in the processing of a grievance, in order to determine the real matter in dispute and to render a decision according to equitable principles and the justice of the case.

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

  • Processing Grievances The grievant shall be granted reasonable time off with pay from regularly scheduled duty hours to process a grievance, provided that the time off will be devoted to the prompt and efficient investigation and handling of grievances, subject to the following:

  • Management Grievance The Employer may initiate a grievance at Step 3 of the grievance procedure by the Employer or designate presenting the grievance to the President of the Union or designate. Time limits and process are identical to a union grievance.

  • Tuberculosis Examination The examination shall consist of an approved intradermal tuberculosis test, which, if positive, shall be followed by an X-ray of the lungs. Nothing in Sections 5163 to 5163.2, inclusive, shall prevent the governing body of any city or county, upon recommendation of the local health officer, from establishing a rule requiring a more extensive or more frequent examination than required by Section 5163 and this section. § 5163.2. Technician taking X-ray film; Interpretation of X-ray The X-ray film may be taken by a competent and qualified X-ray technician if the X-ray film is subsequently interpreted by a licensed physician and surgeon.

  • Technical Objections to Grievance No grievance will be defeated or denied by any minor technical objection.

  • Claims Review Objective A clear statement of the objective intended to be achieved by the Claims Review.

  • Post Service Claims In the case of a Post-Service Claim, CareFirst BlueChoice shall notify the Member of the CareFirst BlueChoice’s Adverse Benefit Determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be extended one time by CareFirst BlueChoice for up to 15 days, provided that CareFirst BlueChoice both determines that such an extension is necessary due to matters beyond the control of CareFirst BlueChoice and notifies the Member, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which CareFirst BlueChoice expects to render a decision. If such an extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Member shall be afforded at least 45 days from receipt of the notice within which to provide the specified information.

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