Common use of Reporting Requirements and Reporting Deliverables Clause in Contracts

Reporting Requirements and Reporting Deliverables. A Provider who has exhausted the Contractor’s internal appeal process shall have a right to appeal a final denial, in whole or in part, by the Contractor to an external independent third party in accordance with applicable state laws and regulations including denials, in whole or in part, involving emergency care services. The Contractor shall provide written notification to the Provider of its right to file an appeal. A provider shall have a right to appeal a final decision by an external independent third party to the Cabinet for Health and Family Services Division of Administrative Hearings for a hearing in accordance with applicable state laws and regulation.

Reporting Requirements and Reporting Deliverables. A Provider who has exhausted the Contractor’s internal appeal process shall have a right to appeal a final denial, in whole or in part, by the Contractor to an external independent third party in accordance with applicable state laws and regulations including denials, in whole or in part, involving emergency care servicesregulations. The Contractor shall provide written notification to the Provider of its right to file an appeal. A provider shall have a right to appeal a final decision by an external independent third party to the Cabinet for Health and Family Services Division of Administrative Hearings for a hearing in accordance with applicable state laws and regulation.