External Appeal Options Sample Clauses

External Appeal Options. State and Federal: Medicaid participants have the right to request a State Fair Hearing if they have completed the PACE CNY appeal process and are still not satisfied with the decision. PACE CNY staff will assist you in accessing your State Fair Hearing rights. State Fair Hearings are conducted by the New York State Office of Hearing and Appeals. If you are a Medicare participant and have completed the PACE CNY Internal Appeal Process and are still not satisfied with the decision, you may choose to appeal to Medicare. PACE CNY staff will assist you in accessing the Medicare appeal process. The appeal will be sent to The Centers for Medicare and Medicaid Services’ (CMS) Independent Review Entity (IRE). If you have both Medicaid and Medicare coverage, PACE CNY staff will assist you in choosing which agency to appeal to and accessing the chosen agency. Both agencies cannot review the appeal.
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External Appeal Options. State and Federal: Medicaid participants have the right to request a State Fair Hearing if they have completed the PACE CNY appeal process and are still not satisfied with the decision. PACE CNY staff will assist you in accessing your State Fair Hearing rights. State Fair Hearings are conducted by the New York State Office of Hearing and Appeals. If you are a Medicare participant and have completed the PACE CNY Internal Appeal Process and are still not satisfied with the decision, you may choose to appeal to Medicare. PACE CNY staff will assist you in accessing the Medicare appeal process. The appeal will be sent to The Centers for Medicare and Medicaid Services’ (CMS) Independent Review Entity (IRE). If you have both Medicaid and Medicare coverage, PACE CNY staff will assist you in choosing which agency to appeal to and accessing the chosen agency. Both agencies cannot review the appeal. Voicing Concerns to the NYS Department of Health You can contact the New York State Department of Health at any time to voice a complaint by writing to: NYS Department of Health One Commerce Plaza 00 Xxxxxxxxxx Xxxxxx Room 1621 Albany, New York 12210 OR, you may call the New York State Hotline: 0-000-000-0000
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External Appeal Options. State and Federal External Appeals may only be requested after you have exhausted XxxxxXXX’s appeal process. If you receive Medicaid, you have the right to request a State Fair Hearing if you have completed the appeal process and are still not satisfied with the decision. ElderONE staff will assist you in accessing Fair Hearing rights. Fair Hearings are conducted by the NYS Office of Hearings and Appeals. If you receive Medicare and have completed the internal appeal process and are still not satisfied, you may choose to appeal to Medicare. ElderONE staff will assist you in accessing the Medicare appeal process. If you receive both Medicaid and Medicare, ElderONE staff will assist in choosing which agency to appeal to and assist you in accessing that process. Both Medicare and Medicaid agencies cannot review the appeal.
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Related to External Appeal Options

  • External Appeals For appeals of a decision that a prescription drug is not covered because it is not on our formulary, please see the Formulary Exception Process in the Prescription Drug and Diabetic Equipment and Supplies section. When filing a reconsideration or an appeal, please provide the same information listed in the Complaints section above.

  • How to Request an External Appeal If you remain dissatisfied with our medical appeal determination, you may request an external review by an outside review agency. In accordance with §27-18.9-8, your external appeal will be reviewed by one of the external independent review organizations (IRO) approved by the Office of the Health Insurance Commissioner. The IRO is selected using a rotational method. Your claim does not have to meet a minimum dollar threshold in order for you to be able to request an external appeal. To request an external appeal, submit a written request to us within four (4) months of your receipt of the medical appeal denial letter. We will forward your request to the outside review agency within five (5) business days, unless it is an urgent appeal, and then we will send it within two (2) business days. We may charge you a filing fee up to $25.00 per external appeal, not to exceed $75.00 per plan year. We will refund you if the denial is reversed and will waive the fee if it imposes an undue hardship for you. Upon receipt of the information, the outside review agency will notify you of its determination within ten (10) calendar days, unless it is an urgent appeal, and then you will be notified within seventy-two (72) hours. The determination by the outside review agency is binding on us. Filing an external appeal is voluntary. You may choose to participate in this level of appeal or you may file suit in an appropriate court of law (see Legal Action, below). Once a member or provider receives a decision at one of the several levels of appeals noted above, (reconsideration, appeal, external), the member or provider may not ask for an appeal at the same level again, unless additional information that could affect such decisions can be provided.

  • External Audit (a) The Beneficiary or the Executing Agency, as the case may be, shall present to the Bank, during the period of Project execution and within the deadlines and with the frequency provided in the Special Conditions of this Agreement, the Project’s financial statements and other reports, and any additional financial information relating thereto that the Bank may request, in accordance with accounting principles and standards acceptable to the Bank.

  • Internal Investigations (A) The parties recognize that Florida Highway Patrol personnel occupy a special place in American society. Therefore, it is understood that the state has the right to expect that a professional standard of conduct be adhered to by all Florida Highway Patrol personnel regardless of rank or assignment. Since internal investigations may be undertaken to inquire into complaints of Florida Highway Patrol misconduct, the state reserves the right to conduct such investigations to uncover the facts in each case, but expressly agrees to carefully guard and protect the rights and dignity of accused personnel. In the course of an internal investigation, the investigative methods employed will be consistent with the law (including but not limited to section 112.532, Florida Statutes) and this agreement; nothing in this agreement, however, shall be deemed to diminish the rights of employees under applicable law.

  • Internal Audit (1) Within sixty (60) days, the Board shall adopt, implement, and thereafter ensure Bank adherence to an independent, internal audit program sufficient to:

  • External Arbitration Procedures Any arbitration initiated under this LGIA shall be conducted before a single neutral arbitrator appointed by the Parties. If the Parties fail to agree upon a single arbitrator within ten (10) Calendar Days of the submission of the dispute to arbitration, each Party shall choose one arbitrator who shall sit on a three-member arbitration panel. The two arbitrators so chosen shall within twenty (20) Calendar Days select a third arbitrator to chair the arbitration panel. In either case, the arbitrators shall be knowledgeable in electric utility matters, including electric transmission and bulk power issues, and shall not have any current or past substantial business or financial relationships with any party to the arbitration (except prior arbitration). The arbitrator(s) shall provide each of the Parties an opportunity to be heard and, except as otherwise provided herein, shall conduct the arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association (“Arbitration Rules”) and any applicable FERC regulations; provided, however, in the event of a conflict between the Arbitration Rules and the terms of this Article 27, the terms of this Article 27 shall prevail.

  • Restrictive Controls Either Party may use protective network traffic management controls such as 7-digit and 10-digit code gaps set at appropriate levels on traffic toward each other's network, when required, to protect the public switched network from congestion due to facility failures, switch congestion, or failure or focused overload. CLEC and CenturyLink will immediately notify each other of any protective control action planned or executed.

  • Internal Controls The Company shall maintain a system of internal accounting controls sufficient to provide reasonable assurances that: (i) transactions are executed in accordance with management’s general or specific authorization; (ii) transactions are recorded as necessary in order to permit preparation of financial statements in accordance with GAAP and to maintain accountability for assets; (iii) access to assets is permitted only in accordance with management’s general or specific authorization; and (iv) the recorded accountability for assets is compared with existing assets at reasonable intervals and appropriate action is taken with respect to any differences.

  • Internal Control Effective control and accountability must be maintained for all cash, real and personal property, and other assets. Grantee must adequately safeguard all such property and must provide assurance that it is used solely for authorized purposes. Grantee must also have systems in place that provide reasonable assurance that the information is accurate, allowable, and compliant with the terms and conditions of this Agreement. 2 CFR 200.303.

  • External monitoring The external monitoring and audit referred to in Articles 11.1, 11.2, 11.3 and 11.4 of the Regulation shall not in any way relieve the National Focal Point or the Programme Operator of their obligations under the legal framework regarding monitoring of the Programme and/or its projects, financial control and audit.

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