External Review Process. External review in the area of professional recognition for traditionally ranked faculty is allowed in the final tenure review. External review may be initiated by the candidate, the DTC, or the department chair. Reviewers external to the faculty of Western Michigan University shall be appropriate to the tenure candidate's specialty area. By mutual agreement of the candidate and the chair of the DTC, one reviewer may be from Western Michigan University, but external to the department.
External Review Process. External review in the area of professional recognition for traditionally ranked faculty may be initiated by the candidate, the DPC, or the department chair, for a candidate’s promotion review. Reviewers external to the faculty of Western Michigan University shall be appropriate to the promotion candidate's specialty area. By mutual agreement of the candidate and the chair of the DPC, one reviewer may be from Western Michigan University, but external to the department.
External Review Process. An external review organization is an independent entity under contract with the State of Minnesota to review health plan appeals. If you or someone acting on your behalf has exhausted, or are deemed under applicable law to have exhausted, PIC’s internal appeals processes as described in the “Internal Appeals Process” section of this contract, you or your authorized representative may file a request for external review, along with your filing fee of $25, as noted below, with the Minnesota Department of Commerce at the address below: External Review Process Minnesota Department of Commerce 00 Xxxx Xxxxxxx Xxxxx Suite 280 St. Xxxx, MN 55101-2198 You are deemed to have exhausted PIC’s internal appeals process, if PIC waives the exhaustion requirement, PIC fails to substantially comply with the requirements of this section or you request an expedited external review at the same time you qualify for and request an acute care service appeal. If you want an external review, you must request it within six months after the date of PIC’s denial determination. Cases involving fraudulent marketing and agent misrepresentation are not eligible for external review. External review decisions are binding on PIC, but are not binding on you. The fee for an external review is $25 and the maximum fee you may be charged in one year for external reviews is $75. This fee may be waived due to hardship and will be refunded by the Minnesota Department of Commerce, its contracted external review organization, or its designee if you prevail and PIC’s denial decision is completely reversed. How to File a Complaint with the Department of Commerce You or someone acting on your behalf may file a complaint with the Commissioner of Commerce at any time. You may reach the Minnesota Department of Commerce at 651.539.1600 within the Twin Cities metropolitan area or by calling 0.000.000.0000 from outside the Twin Cities.
External Review Process. A Member shall have four (4) months from the receipt of notice of the Plan’s decision to appeal the denial resulting from the Internal Appeal Process by requesting external review of the decision. To be eligible for external review, the decision of the Plan to be reviewed must involve:
External Review Process. If a Claimant receives a Final Adverse Benefit Determination under the Plan’s internal Claims and Appeals Procedures, the Claimant may (but does not have to) request that the Claim be reviewed under the Plan’s External Review process. As described in detail below, the External Review process entails a review of the Claim by an independent third-party organization.
External Review 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 for Final Internal Adverse Benefit Determinations based on medical necessity, appropriateness, health care setting, level of care, or effectiveness of a Covered Benefit. Except as set forth in section C above, the right to an External Review 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 of receipt by HMO or 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 10 calendar 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.
External Review Process. Medical Group may elect to subject certain disputes to an external review process (“External Review Election”) as follows:
External Review Process. Plan Sponsor and Plan Administrator acknowledge their responsibility to administer an external review process as described under the Patient Protection and Affordable Care Act, the Health Care and Education Reconciliation Act, 29 CFR 2590.715-2719 and the U.S. Department of Labor Technical Release 2010-01 (“Technical Release 2010-01”). Plan Sponsor and Plan Administrator delegate to BCBSNC the authority to contract with appropriate independent review organizations on their behalf to administer an external review process. BCBSNC shall set up an external review process consistent with the terms of this Agreement and the federal laws and regulatory guidance referenced above. BCBSNC is responsible for making the decision to allow or deny a request for external review based on the preliminary review criteria specified in Technical Release 2010-01.
External Review Process. The Mutual Binding Arbitration portion of the ADR Policy.
