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Dental Appeal Procedures Sample Clauses

Dental Appeal Procedures. Appeal is a verbal or written request for us to reconsider a full or partial denial of payment for services that were denied because we determined that the service does not meet our dental necessity guidelines or orthodontics services were not medically necessary. If we deny payment for a service for dental reasons, you will receive the denial in writing. The written denial you receive will explain the reason for the denial and provide specific instructions for filing a dental appeal. Your dentist may file a dental appeal on your behalf. Your dentist can contact the Provider Call Center to initiate the dental appeal or submit the appeal and all applicable clinical documentation to the address below. To file a dental appeal verbally, you may call our Customer Service Department at (401) 453- 4700 or 0-000-000-0000. You may also file a dental appeal in writing. To do so, you must provide the following information: • name, address, and member ID number; • summary of the dental appeal, • any previous contact with Blue Cross & Blue Shield of Rhode Island, • a brief description of the relief or solution you are seeking; • any more information such as referral forms, claims or any other documentation that you would like us to review; • the date of service; and • your signature. If a dental appeal is being filed on your behalf, you must send us a notice with your signature, authorizing the individual to represent you in this matter. Written dental appeals should be sent to: Blue Cross Dental Attn: Appeals P. O. Box 219 Providence, Rhode Island 02901-0219 You are entitled to the following levels of review when seeking a dental appeal.
Dental Appeal Procedures. Appeal is a verbal or written request for us to reconsider a full or partial denial of payment for services that were denied because we determined that the service does not meet our dental necessity guidelines. If we deny payment for a service for dental reasons, you will receive the denial in writing. The written denial you receive will explain the reason for the denial and provide specific instructions for filing a dental appeal. Your dentist may file a dental appeal on your behalf. Your dentist can contact the Provider Call Center to initiate the dental appeal or submit the appeal and all applicable clinical documentation to the address below. To file a dental appeal verbally, you may call our Customer Service Department at (401) 453- 4700 or 0-000-000-0000. You may also file a dental appeal in writing. To do so, you must provide the following information: • name, address, and member ID number; • summary of the dental appeal, • any previous contact with Blue Cross & Blue Shield of Rhode Island, • a brief description of the relief or solution you are seeking; • any more information such as referral forms, claims or any other documentation that you would like us to review; • the date of service; and • your signature. If a dental appeal is being filed on your behalf, you must send us a notice with your signature, authorizing the individual to represent you in this matter. Written dental appeals should be sent to: Blue Cross Dental Attn: Appeals P. O. Xxx 000 Xxxxxxxxxx, Xxxxx Xxxxxx 00000-0000 You are entitled to the following levels of review when seeking a dental appeal.

Related to Dental Appeal Procedures

  • Appeal Procedures A. Employees may appeal discipline imposed under this LOA through the Dispute Resolution Procedure contained in the Collective Bargaining Agreement (i.e. grievance procedure) or to the Minneapolis Civil Service Commission. B. Concerning disciplinary actions taken pursuant to this drug and alcohol testing LOA, available Civil Service Commission appeal procedures are as follows:

  • Appeal Procedure The Appeal will be deemed an appeal of the entire Arbitration Award. In conducting the Appeal, the Appeal Panel shall conduct a de novo review of all Claims described or otherwise set forth in the Arbitration Notice. Subject to the foregoing and all other provisions of this Paragraph 5, the Appeal Panel shall conduct the Appeal in a manner the Appeal Panel considers appropriate for a fair and expeditious disposition of the Appeal, may hold one or more hearings and permit oral argument, and may review all previous evidence and discovery, together with all briefs, pleadings and other documents filed with the Original Arbitrator (as well as any documents filed with the Appeal Panel pursuant to Paragraph 5.4(a) below). Notwithstanding the foregoing, in connection with the Appeal, the Appeal Panel shall not permit the parties to conduct any additional discovery or raise any new Claims to be arbitrated, shall not permit new witnesses or affidavits, and shall not base any of its findings or determinations on the Original Arbitrator’s findings or the Arbitration Award.

  • Referral Procedures For Local Unions now having a job referral system as contained in their Collective Bargaining Agreement, the Contractor agrees to utilize such system and it shall be used exclusively by such Contractor, except as it may be modified by this Article. Referrals shall not be affected by obligations of Union membership or the lack thereof. Where airport security clearance requirements apply to work to be performed, the Contractor shall inform the Union’s hiring hall dispatcher of those requirements when requesting workers. For those Local Unions having a Book system as part of their Collective Bargaining Agreement, such system will be honored in regards to lay-off of workers from covered projects. Section 2. In the event that Local Unions are unable to fill any request for employees within the time specified by the local CBAs the Contractor may employ applicants from any other available source. The Contractor shall inform the Union of the name and social security number of any applicants hired from other sources and shall refer the applicant to the Local Union for dispatch to the Covered Project prior to the commencement of work, and make trust fund contributions for every hour worked. Section 3. There shall be no discrimination against any employee or applicant for employment because of his/her membership or non-membership in the Union or based upon race, creed, color, sex, age or national origin, or any other legally protected class of such employee or applicant. Section 4. No employee covered by this PLA shall be required to join any Union as a condition of being employed on the Covered Project; provided, however, that an employee who is a member of the referring Union at the time of the referral shall maintain that membership while employed under the PLA. All employees shall, however, be required to comply with the union security provision of the applicable Collective Bargaining Agreement, for the period during which they are performing on-site work, except as modified by this PLA. The Contractor agrees to deduct union dues or representation fees, whichever is applicable, from the pay of any employee who executes a voluntary authorization for such deductions and to remit the dues to the Union or Council. Initiation fees shall be waived for those employees who are not members of any signatory Union when they begin work on this Covered Project. The dues obligations of such employees shall be confined to that portion of union membership dues directly related to representation of workers in collective bargaining, and in enforcement of the Unions’ collective bargaining agreements. Nothing in this Section is intended to eliminate or affect the right of any employee to join the Union or the right of any union to collect full dues from its member. Section 5. The Parties agree that where a Contractor is not party to a current Collective Bargaining Agreement with the Union having jurisdiction over the affected work, the Contractor may request by name, and the Local will honor, referral of up to a maximum of five (5) persons per each contractor (“core” employees), provided that the Contractor first demonstrate that those persons possess the following qualifications: (1) Any license required by state or federal law for the Project work to be performed; (2) Have worked a total of at least one thousand two hundred (1,200) hours in the construction craft during the prior two (2) years; (3) Were on the Contractor’s active payroll for at least sixty (60) out of the ninety (90) calendar days prior to the contract award; (4) Have the ability to perform the work safely. The Contractor may elect to hire its first “core” employee to be a xxxxxxx. After the Contractor hires his first core employee, the Union will refer to such Contractor one journeyman employee from the hiring hall out-of-work list for the affected trade or craft, then refer one of such Contractor’s “core” employees as a journeyman, and shall alternate one core employee and one employee from the out-of-work list, until such Contractor’s crew requirements are met or until such Contractor has hired five (5) “core” employees, whichever occurs first. Thereafter, all additional employees in the affected trade or craft shall be hired exclusively from the hiring hall out-of-work list(s). For the duration of the Contractor’s work the ratio of “core” employees to hiring hall referrals shall be maintained and when the Contractor’s workforce is reduced, employees shall be reduced in the same ratio as was applied in the initial hiring. All employees, core and union, shall be dispatched from the appropriate union. Trust benefits shall be paid on all employees, core and union. Section 6. Upon referral or dispatch from a Union, “turnaround” or refusal of any worker by the Contractors, requires written explanation from the Contractor that shall be communicated through the Prime Contractor to the Port and affected Union within 48 hours. Section 7. Individual seniority will not be recognized or applied to employees working on the Project. This provision will not interfere with or supersede the use by individual Contractors of “call lists” maintained by such Contractor pursuant to addenda to the local Collective Bargaining Agreement between such Contractor and a Union signatory to this PLA. Section 8. The selection of craft foremen and/or general foremen and the number of such foremen and/or general foremen required shall be entirely the responsibility of the Contractor. Craft foremen shall be designated working foremen at the request of the Contractor. Craft workers covered by this PLA will, in the normal day- to-day operations, take their direction and supervision from their xxxxxxx.

  • Appeal Process PROVIDER may appeal any adverse finding by the Contract Compliance Officer as set forth in sec. 25.08(20)(c), D.C. Ords.

  • Reply Procedures In connection with any Auction, each Lender holding the relevant Term Loans subject to such Auction may, in its sole discretion, participate in such Auction and may provide the Auction Agent with a notice of participation (the “Return Bid”) which shall be in a form reasonably acceptable to the Auction Agent, and shall specify (i) a discount to par (that must be expressed as a price at which it is willing to sell all or any portion of such Term Loans) (the “Reply Price”), which (when expressed as a percentage of the par principal amount of such Term Loans) must be within the Discount Range and (ii) a principal amount of such Term Loans, which must be in whole increments of $1,000,000 (or, in any case, such lesser amount of such Term Loans of such Lender then outstanding or which is otherwise reasonably acceptable to the Auction Agent) (the “Reply Amount”). Lenders may only submit one Return Bid per Auction, but each Return Bid may contain up to three bids only one of which may result in a Qualifying Bid. In addition to the Return Bid, the participating Lender must execute and deliver, to be held in escrow by the Auction Agent, an Assignment and Assumption with the dollar amount of the Term Loans to be assigned to be left in blank, which amount shall be completed by the Auction Agent in accordance with the final determination of such Lender’s Qualifying Bid pursuant to clause (c) below. Any Lender whose Return Bid is not received by the Auction Agent by the Auction Response Date shall be deemed to have declined to participate in the relevant Auction with respect to all of its Term Loans.

  • Additional Procedures (i) Once initiated by an Auction Notice, the Auction Party may not withdraw an Auction other than a Failed Auction. Furthermore, in connection with any Auction, upon submission by a Lender of a Qualifying Bid, such Lender (each, a “Qualifying Lender”) will be obligated to sell the entirety or its allocable portion of the Reply Amount, as the case may be, at the Applicable Price. (ii) To the extent not expressly provided for herein, each purchase of Term Loans pursuant to an Auction shall be consummated pursuant to procedures consistent with the provisions in this definition, established by the Auction Agent acting in its reasonable discretion and as reasonably agreed by the Borrower. (iii) In connection with any Auction, the Borrower and the Lenders acknowledge and agree that the Auction Agent may require as a condition to any Auction, the payment of customary fees and expenses by the Auction Party in connection therewith as agreed between the Auction Party and the Auction Agent. (iv) Notwithstanding anything in any Loan Document to the contrary, for purposes of this definition, each notice or other communication required to be delivered or otherwise provided to the Auction Agent (or its delegate) shall be deemed to have been given upon the Auction Agent’s (or its delegate’s) actual receipt during normal business hours of such notice or communication; provided that any notice or communication actually received outside of normal business hours shall be deemed to have been given as of the opening of business on the next Business Day. (v) The Borrower and the Lenders acknowledge and agree that the Auction Agent may perform any and all of its duties under this definition by itself or through any Affiliate of the Auction Agent and expressly consent to any such delegation of duties by the Auction Agent to such Affiliate and the performance of such delegated duties by such Affiliate. The exculpatory provisions pursuant to this Agreement shall apply to each Affiliate of the Auction Agent and its respective activities in connection with any purchase of Term Loans provided for in this definition as well as activities of the Auction Agent.

  • Termination Procedures The Contractor acknowledges that this Agreement may be terminated for Convenience or Default.

  • Medical Procedures 21.01 The Board shall distribute a copy of its Operating Procedures for administration of prescribed medication to pupils in schools and Procedures for health support services to each Teacher. 21.02 In accordance with Operating Procedure Special Education Services 8, a Teacher may refuse without prejudice a request to administer medications except in life-threatening situations.

  • Formal Procedures 1. Upon presentation to the academic Xxxx of a petition signed by one–third (1/3) of the full–time members of the department/work area, excluding the department chair, stating specific reasons for recalling the department chair, the academic Xxxx shall promptly give fourteen (14) calendar days' written notice to all department/work area members setting forth the time, date and place of a meeting to consider the recall petition and to vote on either a motion that the department/work area chair continue in office or a motion to recommend to the President of the College that the President declares a vacancy to exist in the department/work area. The department chairperson/work area may be present at this meeting. 2. The academic Xxxx and an impartial person from the faculty at large, who shall be elected by members of the department/work area, shall conduct the recall meeting, and if the academic Xxxx and the members of the department/work area shall have so decided, shall conduct successor meetings for the same purpose. The academic Xxxx and such impartial person from the faculty at large shall record any subsequent vote(s) taken within the department/work area on this matter. 3. A vote by secret ballot of the majority of all full–time department/work area members shall be required to recommend to the President of the College or the President’s designee that the President declares a vacancy to exist in the department chair position. If a majority of the department/work area members so vote, the results of the balloting with reasons shall be forwarded to the President of the College or the President’s designee. The President of the College shall determine the recall or continuance within ten (10) calendar days and so notify the department/work area with reasons. The President's decision shall be final.

  • Operational Procedures In order to minimize operational problems, it will be necessary for trade information to be supplied in a secure manner by the Subadviser to the Fund’s Service Providers, including: JPMorgan Chase Bank, National Association (the “Custodian”), Virtus Fund Services (the “Fund Administrator”) BNY Mellon Investment Servicing (US) Inc., (the “Sub-Accounting Agent”), any Prime Broker to the Series, and all other Counterparties/Brokers as required. The Subadviser must furnish the Fund’s service providers with required daily information as to executed trades in a format and time-frame agreed to by the Subadviser, Custodian, Fund Administrator, Sub-Accounting Agent and Prime Broker/Counterparties and designated persons of the Fund. Trade information sent to the Custodian, Fund Administrator, Sub-Accounting Agent and Prime Broker/Counterparties must include all necessary data within the required timeframes to allow such parties to perform their obligations to the Series. The Sub-Accounting Agent specifically requires a daily trade blotter with a summary of all trades, in addition to trade feeds, including, if no trades are executed, a report to that effect. Daily information as to executed trades for same-day settlement and future trades must be sent to the Sub-Accounting Agent no later than 4:30 p.m. (Eastern Time) on the day of the trade each day the Fund is open for business. All other executed trades must be delivered to the Sub-Accounting Agent on Trade Date plus 1 by Noon (Eastern Time) to ensure that they are part of the Series’ NAV calculation. (The Subadviser will be responsible for reimbursement to the Fund for any loss caused by the Subadviser’s failure to comply with the requirements of this Schedule A.) On fiscal quarter ends and calendar quarter ends, all trades must be delivered to the Sub-Accounting Agent by 4:30 p.m. (Eastern Time) for inclusion in the financial statements of the Series. The data to be sent to the Sub-Accounting Agent and/or Fund Administrator will be as agreed by the Subadviser, Fund Administrator, Sub-Accounting Agent and designated persons of the Fund and shall include (without limitation) the following: