Independent Medical Review; Appeals Rights Sample Clauses

Independent Medical Review; Appeals Rights. HPN may require a Member to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or Chiropractor who is certified to practice in the same field of practice as the primary treating Physician or Chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review will include a physical exam of the Member and a personal review of all x-rays and reports made by the primary treating Physician or Chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or Chiropractor and the Member within ten (10) working days after the review. If the Member disagrees with the findings of the review, he may submit an appeal for binding arbitration to HPN within thirty (30) days after he receives the report. The arbiter will be selected by mutual agreement of HPN and the Member. The cost and expense for filing arbitration shall be paid by the party initiating the demand for arbitration. The arbiter may award arbitration fees, expenses, and compensation in an equitable fashion, in favor of any party. The decision of the arbiter shall be binding upon the Member and HPN, and the arbiter’s ruling shall be enforceable pursuant to state law. Please refer to Section 10, Appeals Procedures in this AOC for more information.
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Independent Medical Review; Appeals Rights. SHL may require an Insured to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or chiropractor who is certified to practice in the same field of practice as the primary treating Physician or chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review may include a physical exam of the Insured, unless he is deceased, and a personal review of all x-rays and reports made by the primary treating Physician or chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or chiropractor and the Insured within ten (10) working days after the Independent Medical Review. If the Insured disagrees with the findings of the Independent Medical Review, he may submit an appeal for binding arbitration to SHL within thirty (30) days after he receives the report. Please refer to the Appeals Procedures section in this AOC for more information.
Sample 1Sample 2See All (4)
Independent Medical Review; Appeals Rights. HPN may require a Member to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or Chiropractor who is certified to practice in the same field of practice as the primary treating Physician or Chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review will include a physical exam of the Member and a personal review of all x-rays and reports made by the primary treating Physician or Chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or Chiropractor and the Member within ten (10) working days after the review.
Sample 1
Independent Medical Review; Appeals Rights. SHL may require an Insured to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or chiropractor who is certified to practice in the same field of practice as the primary treating Physician or chiropractor or who is formally educated in that field will conduct the review.
Sample 1
Independent Medical Review; Appeals Rights. HPN may require a Member to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or Chiropractor who is certified to practice in the same field of practice as the primary treating Physician or Chiropractor or who is formally educated in that field will conduct the review. Form No. HPN-Ind_AOC(2015) Page 7
Sample 1

Related to Independent Medical Review; Appeals Rights

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  • Office of Inspector General Investigative Findings Expert Review In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 531.102(m-1)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Procurement Related Complaints and Administrative Review 49.1 The procedures for making a Procurement-related Complaint are as specified in the TDS. 49.2 A request for administrative review shall be made in the form provided under contract forms.

  • PROFESSIONAL GRIEVANCE PROCEDURE A. Any claim by the Association or a teacher that there has been a violation, misinterpretation, or misapplication of the terms of the Agreement or violation of any established policy shall be a grievance and shall be resolved through the procedure set forth herein. B. In the event that a teacher, or the Association believes there is a basis for a grievance, the teacher or representative of the Association within thirty (30) working days of the time the teacher knew of the circumstances giving rise to the grievance, shall first discuss the alleged grievance with the building principal either personally or accompanied by the Association Representative. The grievance process may begin at the Superintendent’s level when the building principal is not involved with an alleged incident. C. If, as a result of the informal discussion with the building principal, a grievance still exists, the teacher or representative of the Association may, within ten (10) working days, invoke the formal grievance procedure through the Association on the grievance report form, signed by the grievant and a representative of the Association. Said form shall be available from the Association Representative in each building. A copy of the grievance form shall be delivered to the building principal, it may be filed with the Superintendent or a representative designated by him. D. Within five (5) working days of receipt of the grievance the principal shall meet with the Association in an effort to resolve the grievance. The principal shall indicate his/her disposition of the grievance in writing within five (5) working days of such meeting and shall furnish a copy thereof to the Association. If the Association desires to proceed to the next step, it shall do so within fifteen (15) calendar days of the principal’s disposition. E. If the Association is not satisfied with the disposition of the grievance, or if no disposition has been made within five (5) working days of such meeting (or ten [10] working days from the date of filing, whichever shall be later) the grievance shall be transmitted to the Superintendent. Within seven (7) working days the Superintendent or his/her designee, shall meet with the Association concerning the grievance and shall indicate his/her disposition of the grievance in writing within five (5) working days of such meeting, and shall furnish a copy thereof to the Association. F. If the Association is not satisfied with the disposition of the superintendent, or if no disposition has been received within five (5) working days of such meeting the Association may proceed to a Board Level Hearing. This grievance hearing shall be heard in closed session, so long as it does not violate the open meetings act. If the grievance is not settled at the preceding step, it may be submitted to binding arbitration. Within fifteen (15) working days of the receipt of the Superintendent’s answer, the party choosing to arbitrate must give written notice to the other party, setting forth specifically the nature of the dispute to be arbitrated. The charging party shall file a Demand for Arbitration with the American Arbitration Association within fifteen (15) days from the notification date that arbitration will be pursued. The arbitrator shall be selected by the American Arbitration Association in accordance with its rules, which shall likewise govern the arbitration proceedings. G. The arbitrator shall have no power to rule on any of the following: 1. The termination of services of or failure to re-employ any probationary teacher. 2. Any claim or complaint for which there is another remedial procedure or forum established by law or by regulation having the force of law, including any matter subject to the procedures specified in the Teacher’s Tenure Act (Act IV Public Acts, Extra Session of 1937 of Michigan, as amended). 3. Any matter involving the content of a teacher evaluation. H. The Board and the Association shall not be permitted to assert in such arbitration proceedings any ground or to rely on any evidence not previously disclosed to the other party. The arbitrator shall have no power to alter, add to, or subtract from the terms of this Agreement. Both parties agree to be bound by the decision of the arbitrator and agree that judgment thereon may be entered in any court of competent jurisdiction. I. The fees and expense of the arbitrator shall be shared equally by both parties. J. The time limits provided in this Article shall be strictly observed but may be extended by written agreement of the parties. In the event a grievance is filed after May 15 of any year and strict adherence to the time limits may result in hardship to any party, the Board shall use its best efforts to process such grievance prior to the end of the school term or as soon thereafter as possible.

  • Replacement of Key Personnel The Engineer must notify the State in writing as soon as possible, but no later than three business days after a project manager or other key personnel is removed from association with this contract, giving the reason for removal.

  • Third Party Administrators for Defined Contribution Plans 2.1 The Fund may decide to make available to certain of its customers, a qualified plan program (the “Program”) pursuant to which the customers (“Employers”) may adopt certain plans of deferred compensation (“Plan or Plans”) for the benefit of the individual Plan participant (the “Plan Participant”), such Plan(s) being qualified under Section 401(a) of the Code and administered by TPAs which may be plan administrators as defined in the Employee Retirement Income Security Act of 1974, as amended. 2.2 In accordance with the procedures established in Schedule 2.1 entitled “Third Party Administrator Procedures,” as may be amended by the Transfer Agent and the Fund from time to time (“Schedule 2.1”), the Transfer Agent shall: (a) Treat Shareholder accounts established by the Plans in the name of the Trustees, Plans or TPAs, as the case may be, as omnibus accounts; (b) Maintain omnibus accounts on its records in the name of the TPA or its designee as the Trustee for the benefit of the Plan; and (c) Perform all Services under Section 1 as transfer agent of the Funds and not as a record-keeper for the Plans. 2.3 Transactions identified under Sections 1 and 2 of this Agreement shall be deemed exception services (“Exception Services”) when such transactions: (a) Require the Transfer Agent to use methods and procedures other than those usually employed by the Transfer Agent to perform transfer agency and recordkeeping services; (b) Involve the provision of information to the Transfer Agent after the commencement of the nightly processing cycle of the TA2000 System; or (c) Require more manual intervention by the Transfer Agent, either in the entry of data or in the modification or amendment of reports generated by the TA2000 System, than is normally required.

  • COUNTY’S QUALITY ASSURANCE PLAN The County or its agent will evaluate the Contractor’s performance under this Contract on not less than an annual basis. Such evaluation will include assessing the Contractor’s compliance with all Contract terms and conditions and performance standards. Contractor deficiencies which the County determines are severe or continuing and that may place performance of the Contract in jeopardy if not corrected will be reported to the Board of Supervisors. The report will include improvement/corrective action measures taken by the County and the Contractor. If improvement does not occur consistent with the corrective action measures, the County may terminate this Contract or impose other penalties as specified in this Contract.

  • Staffing Plan The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

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  • Recognition of Union Stewards and Grievance Committee In order to provide an orderly and speedy procedure for the settling of grievances, the Employer acknowledges the rights and duties of the Union Stewards. The Xxxxxxx shall assist any Employee, which the Xxxxxxx represents, in preparing and presenting her grievance in accordance with the grievance procedure.

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