External Review Process Sample Clauses

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.
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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.
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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. 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.
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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: i) a Claim that was denied involving medical judgment, including application of the Plan’s requirements as to medical necessity, appropriateness, health care setting, level of care, effectiveness of a Covered Service or a determination that the treatment is experimental or investigational; or ii) a determination made by the Plan to rescind a Member’s coverage or to deny the enrollment request of an individual due to ineligibility for coverage under this Agreement. In the case of a denied Claim, the request for external review may be filed by either the Member or a health care Provider, with the written consent of the Member in the format required by or acceptable to the Plan. The request for external review should include any reasons, material justification and all reasonably necessary supporting information as part of the external review filing.
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External Review Process. Medical Group may elect to subject certain disputes to an external review process (“External Review Election”) as follows: a. Subject to the provisions of the Provider Manual, Medical Group may elect to subject certain disputes regarding claim payment to the Billing Dispute External Review Process as described therein. The resulting determination with respect to payment of any claims that are the subject of disputes so submitted shall be binding on the parties and not be subject to the other provisions contained herein for dispute resolution. b. Subject to the provisions of the Provider Manual, Medical Group may, if Medical Group is acting on behalf of a Subscriber, elect to subject certain disputes concerning a determination by BCBSTX that a service is not or will not be a Covered Service because it is not Medically Necessary or is experimental or investigational in nature (“Adverse Determination”) to the External Review process described in the Provider Manual. The resulting determination with respect to the appropriateness of such Adverse Determination shall be binding on the parties and not be subject to the other provisions contained herein for dispute resolution.
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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.
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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.
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External Review Process. The Mutual Binding Arbitration portion of the ADR Policy.
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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.
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Related to External Review Process

  • Review Process A/E's Work Product will be reviewed by County under its applicable technical requirements and procedures, as follows:

  • AUDIT REVIEW PROCEDURES Any dispute concerning a question of fact arising under an interim or post audit of this AGREEMENT that is not disposed of by agreement, shall be reviewed by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration. Not later than thirty (30) calendar days after issuance of the final audit report, CONSULTANT may request a review by ALAMEDA CTC’s Deputy Executive Director of Finance and Administration of unresolved audit issues. The request for review will be submitted in writing. Neither the pendency of a dispute nor its consideration by ALAMEDA CTC will excuse CONSULTANT from full and timely performance, in accordance with the terms of this AGREEMENT. CONSULTANT and subconsultants’ contracts, including cost proposals and ICRs, may be subject to audits or reviews such as, but not limited to, an AGREEMENT Audit, an Incurred Cost Audit, an ICR Audit, or a certified public accountant (“CPA”) ICR Audit Workpaper Review. If selected for audit or review, the AGREEMENT, cost proposal and ICR and related workpapers, if applicable, will be reviewed to verify compliance with 48 CFR, Chapter 1, Part 31 and other related laws and regulations. In the instances of a CPA ICR Audit Workpaper Review it is CONSULTANT’s responsibility to ensure federal, state, or local government officials are allowed full access to the CPA’s workpapers including making copies as necessary. The AGREEMENT, cost proposal, and ICR shall be adjusted by CONSULTANT and approved by ALAMEDA CTC to conform to the audit or review recommendations. CONSULTANT agrees that individual terms of costs identified in the audit report shall be incorporated into the contract by this reference if directed by ALAMEDA CTC at its sole discretion. Refusal by CONSULTANT to incorporate audit or review recommendations, or to ensure that the federal, state, or local governments have access to CPA workpapers, will be considered a breach of contract terms and cause for termination of the AGREEMENT and disallowance of prior reimbursed costs.

  • Review Protocol A narrative description of how the Claims Review was conducted and what was evaluated.

  • Review Procedures a. In consultation with the Illinois SHPO, NRCS shall identify those undertakings with little to no potential to affect historic properties and list those undertakings in Appendix A. Upon the determination by the CRS that a proposed undertaking is included in Appendix A, the NRCS is not required to consult further with the SHPO for that undertaking. A list of undertakings with the potential to affect historic properties comprises Appendix B. b. The lists of undertakings provided in Appendices A and B may be modified through consultation and written agreement between the NRCS State Conservationist and the SHPO without requiring an amendment to this Illinois Prototype Agreement. The NRCS State Office will maintain the master list and will provide an updated list to all consulting parties with an explanation of the rationale for classifying the practices accordingly. c. Undertakings identified in Appendix B shall require further review as outlined in Stipulation V. a. The NRCS shall consult with the SHPO to define the undertaking’s APE, identify and evaluate historic properties that may be affected by the undertaking, assess potential effects, and identify strategies for resolving adverse effects prior to implementing the undertaking. 1) NRCS may provide its proposed APE, identification of historic properties and/or scope of identification efforts, and assessment of effects in a single transmittal to the SHPO, provided this documentation meets the substantive standards in 36 CFR Part 800.4-5 and 800.11. 2) The NRCS shall attempt to avoid adverse effects to historic properties whenever possible; where historic properties are located in the APE, NRCS shall describe how it proposes to modify, buffer, or move the undertaking to avoid adverse effects to historic properties. 3) Where the NRCS proposes a finding of "no historic properties affected" or "no adverse effect" to historic properties, the SHPO shall have 30 calendar days from receipt of this documented description and information to review it and provide comments. The NRCS shall take into account all timely comments. i. If the SHPO, or another consulting party, disagrees with NRCS' findings and/or determination, it shall notify the NRCS within the thirty (30) calendar daytime period. The NRCS shall consult with the SHPO or other consulting party to attempt to resolve the disagreement. If the disagreement cannot be resolved through this consultation, NRCS shall follow the dispute resolution process in Stipulation VIII below. ii. If the SHPO does not respond to the NRCS within the thirty (30) calendar day period and/or the NRCS receives no objections from other consulting parties, or if the SHPO concurs with the NRCS' determination and proposed actions to avoid adverse effects, the NRCS shall document the concurrence/lack of response within the review time noted above and may move forward with the undertaking. 4) Where a proposed undertaking may adversely affect historic properties, NRCS shall describe proposed measures to minimize or mitigate the adverse effects, and follow the process in 36 CFR Part 800.6, including consultation with other consulting patties and notification to the ACHP, to develop a Memorandum of Agreement to resolve the adverse effects. Should the proposed undertaking have the potential to adversely affect a known NHL, the NRCS shall, to the maximum extent possible, undertake such planning and actions that may be necessary to minimize harm to the NHL in accordance with 54 U.S.C. § 306107 of the NHPA and 36 CFR Part 800.6 and 800.10, including consultation with the ACHP and respective National Park Service, Regional National Historic Landmark Program Coordinator, to develop a Memorandum of Agreement. d. NRCS will conduct archaeological surveys and will submit reports and other documentation to SHPO for review and comment. When no archaeological sites have been located by the archaeological survey, NRCS may proceed with the proposed undertaking. Reports for negative surveys must be submitted to SHPO on a quarterly basis. All positive and negative reports submitted to SHPO will be sent digitally for submission to the Inventory of Illinois Archaeological Sites (IAS) data file maintained by staff at the Illinois State Museum (ISM) housed under the Illinois Department of Natural Resources (IDNR). The NRCS further agrees that access to specific site location data will be restricted to the CRS, the NRCS field personnel installing conservation practices adjacent to the cultural resource, and the landowner. Specific site location information for individual projects will be maintained in a secure cultural resources file kept in the field offices and will not be available to the public. e. Curation: NRCS personnel will not collect artifactual material during routine field inspections. However, if a professional survey, evaluation testing, or mitigation is required, NRCS shall ensure that all materials and records resulting from cultural resources surveys or data recovery activities on federal or state property are curated by the Illinois State Museum. The NRCS shall ensure that all records resulting from cultural resource surveys or data recovery activities on private property are curated by the Illinois State Museum or an equivalent curation facility in accordance with 36 CFR Part 79. Subject to the landowner's permission, all objects resulting from cultural resources surveys or data recovery activities are maintained by the Illinois State Museum or equivalent research institution until their analysis is complete and they are returned to their owner(s). Although landowners will be encouraged to donate artifactual material, it is understood that objects collected on private land remain the property of the landowner(s) unless the landowner(s) donates the material to the Illinois State Museum or equivalent research institution. This excludes burial goods, as stipulated by XXXXXX.

  • 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 Process ‌ A. The immediate supervisor will meet with an employee at the start of their review period to discuss performance expectations. The employee will receive copies of their performance expectations as well as notification of any modifications made during the review period. Employee work performance will be evaluated during probationary, trial service and transition review periods and at least annually thereafter. Notification will be given to a probationary or trial service employee whose work performance is determined to be unsatisfactory. B. The supervisor will discuss the evaluation with the employee. The employee will have the opportunity to provide feedback on the evaluation. The discussion may include such topics as: 1. Reviewing the employee’s performance; 2. Identifying ways the employee may improve their performance; 3. Updating the employee’s position description, if necessary; 4. Identifying performance goals and expectations for the next appraisal period; and 5. Identifying employee training and development needs. C. The performance evaluation process will include, but not be limited to, a written performance evaluation on forms used by the Employer, the employee’s signature acknowledging receipt of the forms, and any comments by the employee. A copy of the performance evaluation will be provided to the employee at the time of the review. A copy of the final performance evaluation, including any employee or reviewer comments, will be provided to the employee. The original performance evaluation forms, including the employee’s comments, will be maintained in the employee’s personnel file. D. If an employee disagrees with their performance evaluation, the employee has the right to attach a rebuttal. E. The performance evaluation process is subject to the grievance procedure in Article 30. The specific content of a performance evaluation is not subject to the grievance procedure. F. Performance evaluations will not be used to initiate personnel actions such as transfer, promotion, or discipline.

  • Complaints Procedure (a) A formal complaint must be submitted in writing within six months of the last alleged occurrence. (b) A complaint must be submitted through the Union and/or directly to the Executive Director (or the equivalent or designate). When the Executive Director has received a complaint, they will notify the respondent and the union staff representative of the substance of the complaint in writing within 15 days. (c) The complaint must contain the specific instance(s) and date(s) that the alleged harassment occurred, the names of any witnesses, an explanation of how the action constitutes a violation of Article 29 (Harassment), and the remedy sought. (d) The Executive Director or their designate will investigate the complaint and will complete their report in writing within 30 days. (e) The Employer will take action to resolve the complaint within 10 days of receiving the investigator's report. (f) The Employer will advise the respondent, the complainant and the Union in writing of the substance of the investigator's report and the resolution of the complaint. (g) If the resolution involves separating employees, reasonable efforts will be made to relocate or reschedule the respondent. The complainant may agree in writing to be transferred or rescheduled. (h) If the resolution involves separating an employee and a respondent who is not an employee, reasonable efforts will be made to remedy the situation. (i) If the respondent is the Executive Director (or equivalent), or where there are possible systemic issues or multiple complaints, the following process will be used: (1) The complainant will contact the Union. (2) As soon as possible but within 30 days the Union will notify the Executive Director (or equivalent) and CSSEA. Clause 29.4 (a) and (c) apply to the notice. CSSEA will inform the Employer's Board of Directors. (3) CSSEA and the Union will appoint either Xxxxx Xxxxx or Xxxxxx Xxxx to resolve the complaint. (The person appointed is referred to below as "the Appointee".) (4) After consultation with the parties involved, the Appointee will establish the process to resolve the complaint. The process may include - at the Appointee's discretion - any of the following (or any combination of them): fact-finding, mediation, making recommendations or a full report, or conducting an expedited arbitration. In exercising their discretion with respect to the process, the Appointee will consider the parties' desire that the process be fair and expeditious, that it minimizes disruption in the workplace, that it respects individual privacy to the degree possible in the circumstances, and that it keeps costs to a reasonable level. The Appointee will submit any report or recommendations to CSSEA and the Union. The report and recommendations will remain confidential, except for distribution to the Employer's Board of Directors, the complainant and the respondent. The Appointee may stipulate conditions she/he deems appropriate with respect to distribution. Any outcomes of the process are without prejudice or precedent for other proceedings. (5) The Appointee's fees and expenses will be shared by the Employer and the Union. (j) The Employer may take appropriate action, including discipline, against a complainant if the investigation determines that the complaint is frivolous, vindictive or vexatious.

  • ADB’s Review of Procurement Decisions 11. 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.

  • Claims and Review Procedures 6.1 For all claims other than Disability benefits:

  • 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.

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