Reconsideration If We did not attempt to consult with Your Provider who recommended the Covered Service before making an adverse determination, the Provider may request reconsideration by the same clinical peer reviewer who made the adverse determination or a designated clinical peer reviewer if the original clinical peer reviewer is unavailable. For Preauthorization and concurrent reviews, the reconsideration will take place within one (1) business day of the request for reconsideration. If the adverse determination is upheld, a notice of adverse determination will be given to You and Your Provider, by telephone and in writing.
Reconsiderations and Appeals If you experience a problem relating to an authorization review, benefit denial, or other aspect of this plan, we have internal and external procedures to help you resolve your issue. The following sections detail the processes and procedures for filing: • Administrative Appeals; • Medical Reconsiderations and Appeals (including expedited appeals); • Prescription Drug Appeals: and
Administrative Review The Vice President for Academic Affairs shall submit the Committee’s recommendations to the Superintendent/President. He/She shall review the recommendations. If the recommendations of the Superintendent/President differ from those of the Sabbatical Leave Review Committee, the Superintendent/ President shall meet with the Chair of the Sabbatical Leave Review Committee prior to the February Governing Board meeting. The Superintendent/President shall forward the applications to the Governing Board.
Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. Complaints A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.
Claims Review The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.
Procedure for Benefits Modifications 1. Proposals for major retirement benefit modifications will be negotiated in joint meetings with the certified employee organizations whose memberships will be directly affected. Agreements reached between Management and organizations whereby a majority of the members in LACERS are affected shall be recommended to the City Council by the CAO as affecting the membership of all employees in LACERS. Such modifications need not be included in the MOU in order to be considered appropriately negotiated.
Arbitration Decisions Unless otherwise agreed by the Parties, the arbitrator(s) shall render a decision within ninety (90) Calendar Days of appointment and shall notify the Parties in writing of such decision and the reasons therefor. The arbitrator(s) shall be authorized only to interpret and apply the provisions of this LGIA and shall have no power to modify or change any provision of this Agreement in any manner. The decision of the arbitrator(s) shall be final and binding upon the Parties, and judgment on the award may be entered in any court having jurisdiction. The decision of the arbitrator(s) may be appealed solely on the grounds that the conduct of the arbitrator(s), or the decision itself, violated the standards set forth in the Federal Arbitration Act or the Administrative Dispute Resolution Act. The final decision of the arbitrator(s) must also be filed with FERC if it affects jurisdictional rates, terms and conditions of service, Interconnection Facilities, or Network Upgrades.
Additional RO Review Criteria (1) In addition to the requirements in Subparagraph 34A, the RO must:
Duration of Review This Articulation Agreement shall be effective from the date of affixing signatures and is subject to annual review by all parties affixing signatures. Any changes must be written and reflected in a new agreement. If no changes are indicated by the annual review, continuance of this agreement will remain in effect until terminated. Either party may terminate this agreement immediately without cause on 90 days written notice. In the event this agreement is terminated, students who are impacted shall have the opportunity to obtain credit according to the terms herein. Morehead State University ( MSU ) Responsibilities MSU shall be responsible for: ● Ensuring all institutional policies apply to articulated credit courses. ● Ensuring articulated credit is properly documented on postsecondary transcript in accordance with this agreement. ● Providing KDE with current postsecondary primary point of contact information to be published for general inquiries related to this Articulation Agreement and notifying KDE when updates are applicable. Secondary School (K-12) Responsibilities Secondary School (K-12) shall be responsible for: ● Providing detailed information to students in writing (i.e., a syllabus) consistent with the public postsecondary institution policy, which shall include the nature of the course and the expectations and requirements that correspond to its official catalog description. Course requirement information must include course prerequisites, course content, grading policy, attendance requirements, course completion requirements, performance standards, information on adding and dropping courses and other related course information. ● Promoting articulated credit opportunities among qualified high school students, parents and high school faculty. ● Ensuring proper Technical Education Data System (TEDS) data entry is maintained to allow for student testing. ● Ensuring articulated credit documentation (e.g., high school transcript with state course codes identified, CTE EOP assessment certificate(s), industry certification certificate(s)) is provided to the student upon meeting requirements. This document was completed by: bdavis Digitally signed by bdavis Date: 2018.12.10 14:14:21 -05'00' Articulation Agreement Kentucky Department of Education And Xxxxxxxx State University In Reference to Production Crop Career and Technical Education End-of-Program Assessment Agreement Number: AG - 18-19 - 0008 Signature Page The Kentucky Department of Education (KDE) and Morehead State University ( MSU ) enter into this Articulation Agreement on this 10 day of December , 20 18 . This Articulation Agreement shall be effective from the date of affixing signatures and is subject to annual review by all parties affixing signatures. Any changes must be written and reflected in a new agreement. If no changes are indicated by the annual review, continuance of this agreement will remain in effect until terminated. Either party may terminate this agreement immediately for cause or may terminate without cause on 90 days written notice. In the event this agreement is terminated, students who are impacted shall have the opportunity to obtain credit according to the terms herein. In testimony thereof, witness the duly authorized signatures of the parties hereto: Kentucky Department of Education Xxxxx X. Xxxxx, Ph.D. Commissioner of Education Date Morehead State University signed by Xxx Xxxxxx 1/3/2019
Formal Grievance Procedure 1. In the event that a complaint cannot be resolved informally, the parties shall pursue the first step in the formal grievance procedure before making any application for arbitration, unless the College and the AAUP agree in writing to alter the procedure or waive one or more of the steps by proceeding directly to arbitration.
