Common use of Initiating a Formal Appeal Clause in Contracts

Initiating a Formal Appeal. You may initiate a formal appeal by submitting a written request, including all supporting documentation that relates to the appeal to: Member Services Appeals Unit Xxxxxx Permanente 0000 Xxxx Xxxxxxxxx Xxxxxx Xxxxxxxxx, XX 00000 (000) 000-0000 (FAX) The appeal must be filed in writing within 180 days from the date of receipt of the original denial notice. If the appeal is filed after the 180 days, Health Plan will send a letter denying any further review due to lack of timely filing. Each request for a formal appeal will be acknowledged by Health Plan, in writing, within 10 business days of receipt. If Health Plan does not have sufficient information to complete its internal appeal process, the acknowledgement letter will:

Initiating a Formal Appeal. You may initiate a formal appeal by submitting a written request, including all supporting documentation that relates to the appeal to: Member Services Appeals Unit Xxxxxx Permanente 0000 Xxxx Xxxxxxxxx Xxxxxx Xxxxxxxxx, XX 00000 (000) 000-0000 (FAX) The appeal must be filed in writing within 180 days from the date of receipt of the original denial notice. If the appeal xx xxxx is filed after the 180 18 0 days, Health Plan will send a letter denying any further review due to lack of timely filing. Each request for a formal appeal will be acknowledged by Health Plan, in writing, within 10 business days of receipt. If Health Plan does not have sufficient information to complete its internal appeal process, the acknowledgement letter will: