Request for Expedited External Review Sample Clauses

Request for Expedited External Review. Under the following circumstances, the Member may request an expedited external review: a. If the Member received an adverse benefit determination that denied the Member’s claim and: 1. the Member filed a request for an internal Urgent Care appeal; and 2. the delay in completing the internal appeal process would seriously jeopardize the life or health of the Member or the Member’s ability to regain maximum function; or b. Upon receipt of a final internal adverse benefit determination which involves: 1. a medical condition of the Member for which a delay in completing the standard external review would seriously jeopardize the Member’s life or health or the Member’s ability to regain maximum function; or 2. an admission, availability of care, a continued stay, or a health care item or service for which the Member received Emergency Services, but has not been discharged from a facility.
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Related to Request for Expedited External Review

  • External Review In the event of a final internal Adverse Benefit Determination, a Claimant may be entitled to an external review of the Claim. This request must be submitted in writing on an External Review Request form within 120 days of receipt of the Adverse Benefit Determination. The external reviewer will render a recommendation within 45 calendar days unless the request meets expedited criteria, in which case it will be resolved in no later than 72 hours. The external reviewer’s recommendation will be binding. The external reviewer will notify the Claimant of its decision in writing, and the Plan will take action as appropriate to comply with such recommendation. For detailed information about the external review process, please contact XxXxx’s Member Engagement Center.

  • Internal Review The Borrower shall conduct internal reviews to determine the value of all Eligible Portfolio Investments at least once each calendar week which shall take into account any events of which the Borrower has knowledge that adversely affect the value of any Eligible Portfolio Investment (each such value, an “Internal Value”).

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

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