PROVIDER Appeal Process Clause Samples

PROVIDER Appeal Process. If MSHN should deny PROVIDER any additional compensation to which PROVIDER believes it is entitled, PROVIDER shall notify MSHN in writing within thirty (30) days of the date of notification of denial, stating the grounds upon which it bases its claim for such additional compensation. Should MSHN fail to pay or adequately provide for such additional payment to PROVIDER within the thirty (30) days following receipt of notification from PROVIDER, PROVIDER shall have the right and process of appeal as set forth in the Provider Appeals Process defined in the MSHN-SUDSP Manual.
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PROVIDER Appeal Process a. The MCO shall have an internal appeal process through which a health care provider may appeal the MCO decision on behalf of a Member. b. The health care provider appeal process shall not include any appeal rights to the DEPARTMENT or any rights to an administrative hearing.
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PROVIDER Appeal Process a. The MCO shall have an internal appeal process through which a health care provider may grieve the MCO decision on behalf of a Member. The MCO shall provide information on the availability of this process to the providers in the MCO's network. b. The health care provider appeal process shall not include any appeal rights to the DEPARTMENT or any rights to an external appeal through the DOI.
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Related to PROVIDER Appeal Process

  • Appeal Process PROVIDER may appeal any adverse finding by the Contract Compliance Officer as set forth in sec. 25.08(20)(c), D.C. Ords.

  • Appeal Procedures A. Employees may appeal discipline imposed under this LOA through the Dispute Resolution Procedure contained in the Collective Bargaining Agreement (i.e. grievance procedure) or to the Minneapolis Civil Service Commission. B. Concerning disciplinary actions taken pursuant to this drug and alcohol testing LOA, available Civil Service Commission appeal procedures are as follows:

  • Appeal Procedure The Appeal will be deemed an appeal of the entire Arbitration Award. In conducting the Appeal, the Appeal Panel shall conduct a de novo review of all Claims described or otherwise set forth in the Arbitration Notice. Subject to the foregoing and all other provisions of this Paragraph 5, the Appeal Panel shall conduct the Appeal in a manner the Appeal Panel considers appropriate for a fair and expeditious disposition of the Appeal, may hold one or more hearings and permit oral argument, and may review all previous evidence and discovery, together with all briefs, pleadings and other documents filed with the Original Arbitrator (as well as any documents filed with the Appeal Panel pursuant to Paragraph 5.4(a) below). Notwithstanding the foregoing, in connection with the Appeal, the Appeal Panel shall not permit the parties to conduct any additional discovery or raise any new Claims to be arbitrated, shall not permit new witnesses or affidavits, and shall not base any of its findings or determinations on the Original Arbitrator’s findings or the Arbitration Award.

  • Appeals Process (a) The incumbent(s), the designated manager, ▇▇▇▇▇▇▇ or the Employer, can appeal Joint Job Evaluation Committee decisions for existing positions. (b) Appeals may be filed based on the following criteria: (i) The evaluation results are not consistent with the benchmarks, or (ii) Extenuating circumstances, or (iii) A violation of Article 14 of the Collective Agreement. (c) If an incumbent and/or designated manager decides to appeal a Joint Job Evaluation Committee’s decision, their intent to appeal must be submitted by email or written notification to the Compensation Office within ten (10) working days of receipt of the Evaluation Report. (d) If YusApuY or the Employer appeals a Joint Job Evaluation Committee’s decision, it must be submitted by email or written notification to the Employer or YusApuY within ten (10) working days of receipt of the Evaluation Report. (e) Incumbent(s), the designated manager, YusApuY and the Employer shall be notified within five (5) working days of any submitted appeal of a Joint Job Evaluation Committee’s decision. (f) YusApuY and the Compensation Office shall each prepare a written rationale within six (6) months of the appeal being initiated. The rationale shall be based only on the Job Evaluation Questionnaire and related information submitted to the Joint Job Evaluation Committee and shall identify criteria for appeal, the evaluation factor level(s) the Party(s) is appealing/responding to, and the recommended evaluation factor level(s) with supporting justification. (g) A Joint Appeals Committee shall consider an appeal of an evaluation decision made by a Joint Job Evaluation Committee based on the following process: (i) The Joint Appeals Committee shall have access to: all information provided to the Joint Job Evaluation Committee(s); all documentation prepared by the Joint Job Evaluation Committee and written appeal rationale documentation. (ii) Based on all information provided, the Joint Appeals Committee shall determine if there are sufficient grounds to assign a different level to the appealed factor(s), or confirm the factor level(s) assigned by the Joint Job Evaluation Committee. If the Joint Appeals Committee determines that clarification of submitted information is required, the Committee shall interview the incumbent and the designated manager. (iii) The Joint Appeals Committee shall have the right to override any evaluated factor established by the Joint Job Evaluation Committee. (iv) The Joint Appeals Committee shall make a decision within three (3) months of the submission of the written rationales per Article 14.08(f). (v) Joint Appeals Committee decisions shall be made by consensus and shall be final and binding on both Parties. When consensus is not reached, then the appeal and all submitted documentation shall be directed to a Labour/Management committee for binding resolution.

  • COMPLAINT PROCEDURES CONTRACTOR shall maintain and adhere to its written procedures for responding to parent complaints. These procedures shall include annually notifying and providing parents of LEA students with appropriate information (including complaint forms) for the following: (1) Uniform Complaint Procedures pursuant to Title 5 of the California Code of Regulations section 4600 et seq.; (2) Nondiscrimination policy pursuant to Title 5 of the California Code of Regulations section 4960 (a); (3) Sexual Harassment Policy, California Education Code 231.5 (a) (b) (c); (4) Title IX Pupil Grievance Procedure, Title IX 106.8 (a) (d) and 106.9 (a); and (5) Notice of Privacy Practices in compliance with Health Insurance Portability and Accountability Act (HIPAA), if applicable. CONTRACTOR shall include verification of these procedures to the LEA upon request. CONTRACTOR shall immediately notify LEA of any complaints filed against it related to LEA students and provide LEA with all documentation related to the complaints and/or its investigation of complaints, including any and all reports generated as a result of an investigation.