Common use of Level Administrative Appeals Clause in Contracts

Level Administrative Appeals. If a Member is not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level Administrative Appeals. Requests submitted to UCD after one hundred eighty (180) days of receipt of the initial Adverse Benefit Determination will not be considered. UCD will investigate the Member’s concerns. If the Administrative Appeal is overturned, UCD will reprocess the Member’s Claim, if any. If the Administrative Appeal is upheld, UCD will inform the Member of the right to begin the second level Administrative Appeal process. The Administrative Appeal decision will be mailed to the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf, within thirty (30) days of receipt of the Member’s request; unless it is mutually agreed that an extension of time is warranted.

Level Administrative Appeals. If a Member is You are not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level an Administrative AppealsAppeal. Requests submitted to UCD after one hundred eighty (180) days of receipt of the initial Adverse Benefit Determination will not be considered. UCD Persons not involved in previous decisions regarding the initial Adverse Benefit Determination will investigate the Member’s concernsreview Your administrative Appeal. If the Administrative Your administrative Appeal is overturned, UCD will reprocess the Member’s Your Claim, if any. If the Administrative administrative Appeal is upheld, UCD will inform the Member you of the right to begin the second level Administrative Appeal administrative process. The Administrative administrative Appeal decision will be mailed to the MemberYou, his Your authorized representative, or a Provider authorized by You to act on the Member’s Your behalf, within thirty (30) days of receipt of the Member’s request; unless it is mutually agreed that an extension of the time is warranted.