External Appeal Process Sample Clauses

External Appeal Process. In the event the Union and Employee do not agree to the classification decision by the Director, Job Evaluation (or designate), the Union may submit an appeal of this decision to the Employer (Human Resources) within fifteen (15) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) of the reply from the Director, Job Evaluation. The Parties agree that a single external classification consultant (Appeal Chair), agreed to by the Parties, shall be appointed to hear the appeal. Decisions will be based on the Employer's classifications, classification system, current approved job description, job profiles and/or methodology, in effect within Alberta Health Services. The appeal hearing will be scheduled for both Parties to present their rationales and supporting documentation to the classification consultant. This hearing shall be scheduled within sixty (60) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) or within such period as may be mutually agreed between the Parties, from the date that the appeal was advanced to the external level. Both Parties shall submit their respective positions in writing to the other Party and to the Appeal Chair (Classification Consultant) no later than ten
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External Appeal Process. (a) A classification decision may be referred to the External Appeal Process within sixty (60) calendar days of the date the employee received the written response to the Internal Appeal. The request shall be in writing and sent to the Manager, with a copy to Human Resources and the Union. (b) Within thirty (30) calendar days of receipt of the request for External Appeal, the Employer and the Union will exchange all relevant documents to assist in the External Appeal. The documents would normally include, though not limited to, the following: (i) a copy of the reclassification request, an approved job description with all corresponding rationale and documents used in support of the reclassification request; and (ii) copies of all the Employer responses, including all corresponding rationale and documents used in making the internal decision of the Employer and any corresponding rationale and documents used by the Union and/or employee in support of the request. (c) Within thirty (30) calendar days of the exchange of information, the Employer and the Union may meet to review and discuss all relevant Employer and Union documents in order to resolve the matter and/or refer the appeal to a third-party classification consultant. An appeal hearing will be scheduled for the Employer and Union to present their rationales and supporting documentation to the classification consultant. (d) The third-party classification consultant should review the information provided and review the classification allocation on the basis of the classification specifications and the Classification Specification User Manual and determine the appropriate classification allocation for the position. The decision of the third- party consultant will be final and binding. (e) The third-party consultant shall be selected from a standing list of consultants agreed to by the Parties. The standing list will be reviewed annually. (f) In the event that the Parties are unable to agree to a third-party consultant, a name shall be randomly selected from the agreed to list.
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External Appeal Process. (a) When the Union determines that the decision of the Internal Appeal is not satisfactory, they may request an External Appeal within sixty (60) calendar days of the date they received the written response to the Internal Appeal. The Union’s request shall be in writing and sent to Classification and Compensation Department and to the Employee. (b) Upon receipt of the External Appeal request, an operations Manager, an Analyst from the Classification and Compensation Department, or designate, and the Union’s Classification Analyst or designate will meet within sixty (60) calendar days to review all relevant documents from the Employee and the Employer to assist in the External Appeal. The documents would normally include, though not limited to, the following: (i) a copy of the reclassification request, an approved job description with all corresponding rationale and documents used in support of the reclassification request; and (ii) copies of all the Employer and Union responses, including all corresponding rationale and documents used in making the Internal decision of the Employer. (c) Once the representatives, outlined in 40.04 (b), have received all of the necessary documentation, they may take one (1) of the five (5) following approaches: 1. If necessary, request further information or documentation. This could include interviewing or asking questions of the Employee or representatives of the Employer. However, if information is received from the Employee or the Employer, it should be validated by the respective Parties. 2. The representatives may, by consensus, concur with the decision of the Employer, and recommend that no further reconsideration occur. 3. The representatives may, by consensus, concur with the Employee request, and make a recommendation to the Employer that they grant the reclassification request. The review would be conducted on the basis of the classification specifications and the guidelines included in the Classification Specification User Manual. 4. The representatives may, by consensus, agree that a new classification be created if none of the existing classifications are appropriate for the position and direct the Employer to draft a new classification per Article 40.01. 5. Should the representatives be unable to render a recommendation by consensus within the timelines specified in 40.04(b), either Party may refer the matter to Arbitration.
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External Appeal Process. In the event that your appeal is wholly or partially denied, you will be provided with additional appeal rights. If you choose to undertake this second level of appeal, a member of the interdisciplinary team will assist you in preparing a request for a fair hearing no later than 30 days from the date you received the written denial. ESP will forward the appropriate appeal to the Executive Office of Health and Human Services Board of Hearings, if you request him/ her to do so. Executive Office of Health and Human Services Board of Hearings 000 Xxxxxxx Xx. Quincy, MA 02171 Phone: 000-000-0000 or 0-000-000-0000 Fax: (000) 000-0000 Medicare Managed Care and PACE Reconsideration Suite 702 0000 Xxxxxx Xxx Xxxxxxxxxx, XX 00000-0000 Phone: (000) 000-0000 You can expect to be notified by the Executive Office of Health and Human Service Board of Hearings at least ten days before the fair hearing regarding the date, time, and place of the hearing. You have a right to be assisted at the hearing and if you are not fluent in English, the Board of Hearings will provide an interpreter. At ESP, our mission is to provide you with quality health care services. We affirm the dignity and worth of each participant by assuring the following rights.
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External Appeal Process. In the event the Employee does not agree to the classification decision by the Director, Job Evaluation (or designate), the Employee may request the Union advance the appeal to be heard by a Third Party (External) Classification Consultant within fifteen (15) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) of the reply from the Director, Job Evaluation. The hearing with the Third Party (External) Classification Consultant will be comprised of three (3) members: one (1) member appointed by the Union (Union Representative Classification), one (1) member appointed by the Employer (Human Resources-Job Evaluation), and the Third Party (External) Classification Consultant who shall act as an Appeal Chair. The Third Party (External) Classification Consultant (Appeal Chair) shall be selected from a standing list of external consultants agreed to by the Parties. The fees and expenses of the Chair shall be shared equally between the Parties. The appeal hearing will be scheduled for both Parties to present and discuss their rationales and supporting documentation with the attendees at the hearing as identified above. This hearing shall be scheduled within sixty
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External Appeal Process. Any Member, or any Provider acting on behalf of a Member, with the Member’s consent, who is dissatisfied with the result of the Level One Appeal and Level Two Appeal process above, shall have the right to pursue their appeal to an independent utilization review organization (IURO) in accordance with the procedures set forth below. Except as set forth in section C above, the right to an external appeal under this section shall be contingent upon the Member’s full compliance with both stages of the HMO Level One and Level Two Appeal processes, except that you and any Provider acting on your behalf with your consent shall be relieved of the carrier’s internal appeal process and may pursue an appeal through the Independent Health Care Appeals program if: • A determination on any appeal regarding urgent or emergency care is not forthcoming from HMO within 72 hours or receipt by HMO of notice (in the manner required under the plan) of the appeal; • A determination on an initial appeal, other than one regarding urgent or emergency care, is not forthcoming from HMO within 5 business days of the date that HMO received notice (in the manner required under the plan) of the appeal; or • A determination of a subsequent level of appeal, other than one regarding urgent or emergency care, is not forthcoming from HMO within 20 business days of the date that HMO received notice (in the manner required under the plan) of the appeal. 1. Within 60 calendar days from receipt of the written determination of the Level Two Appeal panel, the Member, or a Provider acting on behalf of the Member with the Member’s consent, shall file a written request with the New Jersey Department of Banking and Insurance. The request shall be filed on forms, if applicable, provided to the Member by HMO and include both a filing fee and a general release executed by the Member for all medical records pertinent to the appeal. The request shall be mailed to: Trenton, New Jersey 00000-0000 Main Telephone Number: (000) 000-0000 Fax: (000) 000-0000 2. The fee for filing an appeal shall be $25.00, payable by check or money order to the New Jersey Department of Banking and Insurance. Upon a determination of financial hardship, the fee may be reduced to $2.00. Financial hardship may be demonstrated by the Member through evidence of eligibility for either the Pharmaceutical Assistance to the Aged and Disabled, Medicaid, NJ FamilyCare, General Assistance, SSI, or New Jersey Unemployment Assistance. 3. Upon rec...
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External Appeal Process. In the event that your internal appeal is wholly or partially denied, you will be provided with additional appeal rights under Medicare or Medicaid. Which process you use will depend on your eligibility. If you have both Medicare and Medicaid, you may choose one or the other, but not both. CHA PACE can help you decide which process to use.
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External Appeal Process. In the event that your appeal is wholly or partially denied, you will be provided with additional appeal rights. If you choose to undertake this second level of appeal, a member of the interdisciplinary team will assist you in preparing a request for a fair hearing no later than 30 days from the date you received the written denial. CHA PACE will forward the appropriate appeal to the Executive Office of Health and Human Services Board of Hearings, if you request him/ her to do so. Mailing Address: Executive Office of Health and Human Services Board of Hearings 000 Xxxxxxx Xx. Quincy, MA02171 Phone: (000) 000-0000 or 0-000-000-0000 Fax: (000) 000-0000 Mailing Address: Medicare Managed Care and PACE Reconsideration Suite 702 0000 Xxxxxx Xxx Pittsfield, NY14534-1302 Phone: (000) 000-0000 You can expect to be notified by the Executive Office of Health and Human Service Board of Hearings at least ten days before the fair hearing regarding the date, time, and place of the hearing. You have a right to be assisted at the hearing and if you are not fluent in English, the Board of Hearings will provide an interpreter.
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Related to External Appeal Process

  • 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 Arbitration Procedures Any arbitration initiated under this Agreement shall be conducted before a single neutral arbitrator appointed by the Parties. If the Parties fail to agree upon a single arbitrator within ten

  • Sxxxxxxx-Xxxxx; Internal Accounting Controls The Company and the Subsidiaries are in compliance with any and all applicable requirements of the Sxxxxxxx-Xxxxx Act of 2002 that are effective as of the date hereof, and any and all applicable rules and regulations promulgated by the Commission thereunder that are effective as of the date hereof and as of the Closing Date. The Company and the Subsidiaries maintain a system of internal accounting controls sufficient to provide reasonable assurance that: (i) transactions are executed in accordance with management’s general or specific authorizations, (ii) transactions are recorded as necessary to permit preparation of financial statements in conformity with GAAP and to maintain asset accountability, (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 the existing assets at reasonable intervals and appropriate action is taken with respect to any differences. The Company and the Subsidiaries have established disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the Company and the Subsidiaries and designed such disclosure controls and procedures to ensure that information required to be disclosed by the Company in the reports it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the Commission’s rules and forms. The Company’s certifying officers have evaluated the effectiveness of the disclosure controls and procedures of the Company and the Subsidiaries as of the end of the period covered by the most recently filed periodic report under the Exchange Act (such date, the “Evaluation Date”). The Company presented in its most recently filed periodic report under the Exchange Act the conclusions of the certifying officers about the effectiveness of the disclosure controls and procedures based on their evaluations as of the Evaluation Date. Since the Evaluation Date, there have been no changes in the internal control over financial reporting (as such term is defined in the Exchange Act) of the Company and its Subsidiaries that have materially affected, or is reasonably likely to materially affect, the internal control over financial reporting of the Company and its Subsidiaries.

  • Xxxxxxxx-Xxxxx; Internal Accounting Controls The Company and the Subsidiaries are in compliance with any and all applicable requirements of the Xxxxxxxx-Xxxxx Act of 2002 that are effective as of the date hereof, and any and all applicable rules and regulations promulgated by the Commission thereunder that are effective as of the date hereof and as of the Closing Date. The Company and the Subsidiaries maintain a system of internal accounting controls sufficient to provide reasonable assurance that: (i) transactions are executed in accordance with management’s general or specific authorizations, (ii) transactions are recorded as necessary to permit preparation of financial statements in conformity with GAAP and to maintain asset accountability, (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 the existing assets at reasonable intervals and appropriate action is taken with respect to any differences. The Company and the Subsidiaries have established disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the Company and the Subsidiaries and designed such disclosure controls and procedures to ensure that information required to be disclosed by the Company in the reports it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the Commission’s rules and forms. The Company’s certifying officers have evaluated the effectiveness of the disclosure controls and procedures of the Company and the Subsidiaries as of the end of the period covered by the most recently filed periodic report under the Exchange Act (such date, the “Evaluation Date”). The Company presented in its most recently filed periodic report under the Exchange Act the conclusions of the certifying officers about the effectiveness of the disclosure controls and procedures based on their evaluations as of the Evaluation Date. Since the Evaluation Date, there have been no changes in the internal control over financial reporting (as such term is defined in the Exchange Act) of the Company and its Subsidiaries that have materially affected, or is reasonably likely to materially affect, the internal control over financial reporting of the Company and its Subsidiaries.

  • Internal Accounting Controls The Company and each of its subsidiaries maintain a system of internal accounting controls sufficient to provide reasonable assurance that (i) transactions are executed in accordance with management's general or specific authorizations, (ii) transactions are recorded as necessary to permit preparation of financial statements in conformity with generally accepted accounting principles and to maintain asset accountability, (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 the existing assets at reasonable intervals and appropriate action is taken with respect to any differences.

  • Internal Accounting and Disclosure Controls The Company and each of its Subsidiaries maintains internal control over financial reporting (as such term is defined in Rule 13a-15(f) under the 0000 Xxx) that is effective to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles, including that (i) transactions are executed in accordance with management’s general or specific authorizations, (ii) transactions are recorded as necessary to permit preparation of financial statements in conformity with generally accepted accounting principles and to maintain asset and liability accountability, (iii) access to assets or incurrence of liabilities is permitted only in accordance with management’s general or specific authorization and (iv) the recorded accountability for assets and liabilities is compared with the existing assets and liabilities at reasonable intervals and appropriate action is taken with respect to any difference. The Company maintains disclosure controls and procedures (as such term is defined in Rule 13a-15(e) under the 0000 Xxx) that are effective in ensuring that information required to be disclosed by the Company in the reports that it files or submits under the 1934 Act is recorded, processed, summarized and reported, within the time periods specified in the rules and forms of the SEC, including, without limitation, controls and procedures designed to ensure that information required to be disclosed by the Company in the reports that it files or submits under the 1934 Act is accumulated and communicated to the Company’s management, including its principal executive officer or officers and its principal financial officer or officers, as appropriate, to allow timely decisions regarding required disclosure. Neither the Company nor any of its Subsidiaries has received any notice or correspondence from any accountant or other Person relating to any potential material weakness or significant deficiency in any part of the internal controls over financial reporting of the Company or any of its Subsidiaries.

  • Complaints Process The School shall establish and adhere to a process for resolving public complaints which shall include an opportunity for complainants to be heard. The final administrative appeal shall be heard by the School's Governing Board, except where the complaint pertains to a possible violation of any law or term under this Contract. The complaints process shall be readily accessible from the School’s website, as described in Section 11.4.1.

  • Legal Appeals a. Nothing contained in these provisions is intended to limit or impair the rights of any vendor or Contractor to seek and pursue remedies of law through the judicial process. Appendix C, Contract Modification Procedure, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. Appendix D, Pricing Schedules, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. The Parties expressly agree that these prices are established as “maximum Not-To-Exceed prices”. The Contractor acknowledges that any mini-bid under this Centralized Contract which includes pricing in excess of the “maximum Not-To-Exceed price” shall be rejected by the Authorized User. Amendments to Appendix D, Pricing Schedules, shall be processed in accordance with Appendix C, Contract Modification Procedure, section 4.8, OGS Centralized Contract Modifications and section 4.23 Price Adjustments for OGS Centralized Contracts. Appendix E, Report of Contract Purchases, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to make unilateral changes to this Report of Contract Purchases document. Appendix F, Project Based Information Technology Consulting Services Processes and Forms, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to change the processes and forms set forth Appendix F in non-material and substantive ways without seeking a contract amendment. Appendix F is comprised of the following attachments: a. Attachment 1- Mini-Bid Template b. Attachment 2- How to Use This Contract c. Attachment 3- Enhancement Request Template d. Attachment 4- No Cost Change Request Template e. Attachment 5- Mini-Bid Participation Interest Template Appendix G, Contractor and OGS Information, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. The Parties agree that the elements identified in 4.7.1 below, OGS Designated Contact information, and information regarding Procurement Card acceptance as presented in Appendix G can be updated without the Parties engaging in a formal contract amendment. All other changes must be handled through the Contract Modification Process or a formal contract amendment.

  • Books and Records; Internal Accounting Controls The records and documents of the Company and its Subsidiaries accurately reflect in all material respects the information relating to the business of the Company and the Subsidiaries, the location and collection of their assets, and the nature of all transactions giving rise to the obligations or accounts receivable of the Company or any Subsidiary. The Company and each of its Subsidiaries maintain a system of internal accounting controls sufficient, in the judgment of the Company's board of directors, to provide reasonable assurance that (i) transactions are executed in accordance with management's general or specific authorizations, (ii) transactions are recorded as necessary to permit preparation of financial statements in conformity with generally accepted accounting principles and to maintain asset accountability, (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 the existing assets at reasonable intervals and appropriate actions are taken with respect to any differences.

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