First Level Formal Appeal Sample Clauses

First Level Formal Appeal. The employee and/or the Association shall submit a written statement of appeal to the respondent within ten (10) workdays from the conclusion of the dialog outlined in part B. above. The appeal statement shall contain: 1) a statement of the relevant facts; 2) the management action or inaction which allegedly violated the Agreement; 3) the provisions of the Agreement allegedly violated; and 4) a proposed remedy which would resolve the appeal. The affected employee(s) may accompany the Association representative in presenting the appeal statement. The respondent shall review the appeal, if necessary, arrange a meeting for further discussion, and provide a written response to the employee(s) and the Association within ten (10) working days from the submission of the written appeal, or from the conclusion of the above contextual discussion, whichever is later.
Sample 1
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First Level Formal Appeal. If Contractor disagrees with the UM Physician/Advisor’s decision after an informal appeal, a first level formal appeal shall be submitted to the UM Deputy Medical Executive (DME). Contractor must appeal in writing to the address below, within sixty (60) calendar days of receipt of the UM Physician/Advisor’s notice to uphold the denial or deferral of service: Attention: Utilization Management Deputy Medical Executive Utilization Management California Correctional Health Care Services P.O. Box 588500 Elk Grove, CA 95758 The UM DME will evaluate the appeal and respond within sixty (60) calendar days.
Sample 1

Related to First Level Formal Appeal

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

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