External Review or Rescission Appeals Sample Clauses

External Review or Rescission Appeals. If a Member still disagrees with the Appeals denial, the Member may request an independent External Appeal conducted by a non-affiliated Independent Review Organization (IRO), which will be randomly assigned by the Louisiana Department of Insurance. Within one hundred twenty (120) days of receipt of the initial Appeal decision, the Member should send his written request for an External Review to: Blue Cross and Blue Shield of Louisiana Medical Appeals P. O. Box 98022 Baton Rouge, LA 70898-9022 Requests submitted to Us after one hundred twenty (120) days of receipt of the denial will not be considered. You are required to sign a form authorizing release of medical records for review by the IRO. We will provide the IRO all pertinent information necessary to conduct the Appeal. The IRO decision will be considered a final and binding decision on both the Member and Us. The IRO review will be completed within forty five (45) days of Our receipt of the request. The IRO will notify the Member or his authorized representative and his health care Providers of its decision. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000
Sample 1Sample 2
AutoNDA by SimpleDocs
External Review or Rescission Appeals. If a Member still disagrees with the Appeals denial, the Member may request an independent External Appeal conducted by a non-affiliated Independent Review Organization (IRO), which will be randomly assigned by the Louisiana Department of Insurance. Within one hundred twenty (120) days of receipt of the initial Appeal decision, the Member should send his written request for an external review to Us. Requests submitted to Us after one hundred twenty (120) days of receipt of the denial will not be considered. You are required to sign a form authorizing release of medical records for review by the IRO. We will provide the IRO all pertinent information necessary to conduct the Appeal. The IRO decision will be considered a final and binding decision on both the Member and the Company. The IRO review will be completed within forty five (45) days of Our receipt of the request. The IRO will notify the Member or his authorized representative and his health care Provider of its decision. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000
Sample 1

Related to External Review or Rescission Appeals

  • Classification Appeal Procedure An employee shall have the right to appeal, through the Union, the classification of the position the employee occupies, or where a point rating plan has been used, the right to appeal the position's level. Classification matters are not grievable under Article 8 of this Agreement. Instead, the following procedures shall be followed.

  • 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 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 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 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 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:

  • Appeals Procedure If Employee appeals to the Administrator, Employee or his authorized representative may submit in writing whatever issues and comments he believes to be pertinent. The Administrator shall reexamine all facts related to the appeal and make a final determination of whether the denial of benefits is justified under the circumstances. The Administrator shall advise Employee in writing of:

  • 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.

  • Complaints Procedure 18.1 If the Client has any cause for complaint in relation to the services provided by the Company, he should file a complaint as per the Company’s Complaint Handling policy which is available on the Company’s website.

  • Review Procedure If the Plan Administrator denies part or all of the claim, the claimant shall have the opportunity for a full and fair review by the Plan Administrator of the denial, as follows:

  • Evaluation Procedure The procedural requirements set forth in this agreement to provide specificity to the statutory obligations established under sections 3319.111 and 3319.112 of the Ohio Revised Code and to conform to the framework for the evaluation of teachers developed under section 3319.112 of the Ohio Revised Code.

  • ADB’s Review of Procurement Decisions 9. All contracts procured under international competitive bidding procedures and contracts for consulting services shall be subject to prior review by ADB, unless otherwise agreed between the Borrower and ADB and set forth in the Procurement Plan. SCHEDULE 5

  • Disciplinary Appeals All forms of disciplinary action which are not appealable to the Civil Service Commission or the courts, except written or oral reprimands and Forms 475, shall be subject to review through Steps 3, 4, 5 and 6 of the grievance procedure.

  • Claims Review Findings a. Narrative Results.‌‌

Time is Money Join Law Insider Premium to draft better contracts faster.