Reconsideration Review Process Sample Clauses

Reconsideration Review Process. (1) Unless CMS has issued a revised Reconciliation Report pursuant to Article 7.3(b)(4), the Participant may request a reconsideration review of the CMS Calculation Error Response issued pursuant to Article 7.3(b)(2) by a designee of CMS who is authorized to receive such requests and did not participate in the determination that is the subject of the reconsideration request (“Reconsideration Official”). The reconsideration review request must be submitted within 10 Days from the issue date of the CMS Calculation Error Response, in a form and manner and to an individual or office specified by CMS. The reconsideration review request must provide a detailed explanation of the basis for the dispute and include supporting documentation for the Participant’s assertion that CMS or its representatives did not accurately calculate the NPRA or Repayment Amount in accordance with this Agreement.
Sample 1
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Reconsideration Review Process. (1) Unless CMS has issued a revised Post-Episode Spending Calculation Report correcting the error pursuant to Article 7.4(b)(4), the Participant may request a reconsideration review of the CMS Post-Episode Spending Calculation Error Response provided pursuant to Article 7.4(b)(2) by a designee of CMS who is authorized to receive such requests and did not participate in the determination that is the subject of the reconsideration request (“Reconsideration Official”). The reconsideration review request must be submitted within 10 Days from the issue date of the CMS Post-Episode Spending Calculation Error Response, in a form and manner and to an individual or office specified by CMS. The reconsideration review request must provide a detailed explanation of the basis for the dispute and include supporting documentation for the Participant’s assertion that CMS or its representatives did not accurately calculate the Excess Spending Amount in accordance with this Agreement.
Sample 1

Related to Reconsideration Review Process

  • Review Process A/E's Work Product will be reviewed by County under its applicable technical requirements and procedures, as follows:

  • Claims Review Objective A clear statement of the objective intended to be achieved by the Claims Review.

  • Claims Review Population A description of the Population subject to the Claims Review.

  • 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.

  • Review Procedure If the Plan Administrator denies part or all of the claim, the claimant shall have the opportunity for a full and fair review by the Plan Administrator of the denial, as follows:

  • Scope of Review I conducted my review in accordance with Thai Standard on Review Engagements 2410, “Review of Interim Financial Information Performed by the Independent Auditor of the Entity.” A review of interim financial information consists of making inquires, primarily of persons responsible for financial and accounting matters, and applying analytical and other review procedures. A review is substantially less in scope than an audit conducted in accordance with Thai Standards on Auditing and consequently does not enable me to obtain assurance that I would become aware of all significant matters that might be identified in an audit. Accordingly, I do not express an audit opinion.

  • Claims Review Findings a. Narrative Results.‌‌

  • Transition Review Period In accordance with Article 35, Layoff and Recall, the Employer may require an employee to complete a transition review period.

  • 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.

  • Review Stages The Project Architect shall submit documents to the Owner for review at completion of the Schematic Design Phase, Design Development Phase and at the following stages of completion of the Construction Documents Phase as follows: 50%, 75%, 100%

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