Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit. If we deny payment for a service we determine not medically necessary, a determination letter will be provided with the following information: • reason for the denial; • clinical criteria used to make the determination as well as how to obtain a copy of the clinical criteria; and • instructions for filing a medical appeal.
Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit. If we deny payment for a service we determine not dentally necessary or not medically necessary (orthodontic services), a determination letter will be provided with the following information: • reason for the denial; • clinical criteria used to make the determination as well as how to obtain a copy of the clinical criteria; and • instructions for filing an appeal. If you have questions, please contact Blue Cross Dental Customer Service. See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program (RIREACH) at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a dentist. A complaint is not an appeal. For information about submitting an appeal, please see the Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your dental treatment with the dentist that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your dentist, you can call Blue Cross Dental Customer Service for further assistance. You may also call Blue Cross Dental Customer Service if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with Blue Cross Dental Customer Service. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. We will conduct a thorough review of your complaint and respond within thirty (30) business days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief d...
Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit.
Denials. A. By entering into this Agreement, Hilcorp shall not be deemed as admitting any violation of the OPA and OSPRA or any rules or regulations promulgated there under.
B. The Trustees do not, by consenting to this Agreement, warrant in any manner that actions taken by Hilcorp pursuant to this Agreement will result in satisfactory performance of the Work.
C. The Trustees shall not be responsible or liable for any adverse impacts that are directly or indirectly related to Hilcorp’s performance of its obligations under this Agreement.
D. The Trustees shall not be liable for any property damage or personal injury caused by Hilcorp’s implementation of the RIMP.
E. The Trustees shall not be liable for the actions of Hilcorp’s agents, employees, assigns, partners or subcontractors and Hilcorp shall fully defend and indemnify and hold harmless the Trustees from any and all suits, actions, damages and costs of every name and description relating to personal injury and damage to real or personal tangible property caused by Hilcorp, its agents, employees, partners or subcontractors, without limitation; provided, however, that Hilcorp shall not indemnify for that portion of any claim, loss or damage arising hereunder due to the negligent act or failure to act of the Trustees.
Denials. If a claim for a Retirement Benefit under the Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant by the Administrator within a reasonable period of time after receipt of the claim by the Administrator.
Denials. The CONTRACTOR shall:
(a) clearly document in English or other prevalent language, as appropriate, on a form agreed to by HSD, and communicate in writing the reasons for any denial to requesting Network Providers, Non-Network Providers, and the Member;
(b) establish and maintain a well-publicized internal and accessible Grievance and Appeal mechanism for both Providers and Members. The notification of a denial shall include a description of how to file a Grievance and Appeal in the CONTRACTOR’s system and how to obtain an HSD Fair Hearing, see 42 C.F.R. §438, subparts (H) and (F); and
(c) recognize that a UR decision resulting from HSD Fair Hearing conducted by the designated HSD official is final and shall be honored by the CONTRACTOR. However, the CONTRACTOR shall have the right to dispute the financial responsibility for the decision through the dispute resolution process set forth in this Agreement and seek judicial review of HSD’s Fair Hearing decision.
Denials i. The CONTRACTOR shall clearly document in English or Spanish, as appropriate, on a form agreed to by HSD, and communicate in writing the reasons for each denial. A "denial" is defined as a refusal by the CONTRACTOR to authorize a service requested or recommended by the member's health care provider.
Denials. In the event a request for voluntary transfer is denied, a unit member may 4 reapply during the internal promotional process.
Denials. A denial of a request for flextime will contain the reasons for the denial in writing to the employee within ten working days of the request being submitted.
Denials. Symphonic and/or DSP may deny any Client Content for the following reasons:
(i) if, in the opinion of Symphonic and/or DSPs, such distribution might violate a statute, law or regulation, or violate any rights of any persons or entities, including suspected violation of the intellectual property of another, (ii) Symphonic and/or DSP believes that its distribution of any of Client’s recordings hereunder would constitute a breach by Client of any of Client’s agreements, warranties or representations contained herein or if Symphonic and/or DSP reasonably deems the recording or the associated artwork to be offensive to reasonable standards of public morals, or (iii) the submitted recording does not comply with the current specification stated on SymphonicMS. Notwithstanding the preceding sentence, in the event the objectionable material is later eliminated or the source of objection is removed, Client may resubmit recording to Symphonic for review and possible distribution hereunder.
