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: Xxxxxx Permanente Appeals & Complaints Resolution 0000 Xxxx Xxxxxxxxx Xxxxxx Xxxxxxxxx, XX 00000 Fax: 0-000-000-0000 The Appeal must be filed in writing within one-hundred eighty (180) days from the date of receipt of the original denial notice. If the Appeal is filed after the one-hundred eighty (180) days, the 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 the Health Plan, in writing, within ten (10) business days of receipt. If the 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: Xxxxxx Permanente Appeals & Complaints Resolution Coordinator Nine Piedmont Center 0000 Xxxx Xxxxxxxxx Xxxxxx XxxxxxxxxXxxxxxxx Xx XX Xxxxxxx, XX 00000 Fax: 0-(000-) 000-0000 (FAX) The Appeal must be filed in writing within one-hundred eighty (180) days from the date of receipt of the original denial notice. If the Appeal is filed after the one-hundred eighty (180) days, the 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 the Health Plan, in writing, within ten (10) business days of receipt. If the 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 appeal by submitting a written request, including all supporting documentation that relates to the Appeal appeal to: Member Services Appeals Unit Xxxxxx Permanente Appeals & Complaints Resolution 0000 Xxxx Xxxxxxxxx Xxxxxx Xxxxxxxxx, XX 00000 By Fax: 0-(000-) 000-0000 The Appeal appeal must be filed in writing within one-hundred eighty (180) days from the date of receipt of the original denial notice. If the Appeal appeal is filed after the one-hundred eighty (180) 180 days, the Health Plan will send a letter denying any further review due to lack of timely filing. Each request for a formal Appeal appeal will be acknowledged by the Health Plan, in writing, within ten (10) business days of receipt. If the Health Plan does not have sufficient information to complete its internal Appeal appeal process, the acknowledgement letter will: