Common use of Level Dental Necessity Appeals Clause in Contracts

Level Dental Necessity 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 Dental Necessity 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 Dental Necessity Appeal is overturned, UCD will reprocess the Member’s Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform the Member of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity 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 Dental Necessity 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 Dental Necessity Appeals. Requests submitted to UCD after one hundred eighty (180) days of receipt of the t he initial Adverse Benefit Determination will not be considered. UCD will investigate the Member’s concerns. If the Dental Necessity Appeal is overturned, UCD will reprocess the Member’s Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform the Member of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity 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 Dental Necessity 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 Dental Necessity 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 Dental Necessity Appeal is overturned, UCD will reprocess the Member’s Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform the Member of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity 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.