Common use of Retrospective Appeal Clause in Contracts

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 30 contracts

Samples: www.aetnastudenthealth.com, www.bcbswny.com, Preferred Provider Organization Insurance Contract

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Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 the earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal requestor 60 days of receipt of the appeal. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 11 contracts

Samples: Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 the earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal requestor 60 days of receipt of the Appeal. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 6 contracts

Samples: Preferred Provider, Preferred Provider, Preferred Provider

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 30 calendar days of receipt of the Appeal requestrequestthe earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal or 60 days of receipt of the Appeal. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 6 contracts

Samples: Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 the earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal request. or 60 days of receipt of the Appeal.. Written notice of the determination will be provided to You (or Your designee), designee and where appropriate, appropriate Your Provider, Provider within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 4 contracts

Samples: mydental.guardianlife.com, assets.ctfassets.net, mydental.guardianlife.com

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 the earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal requestor 60 days of receipt of the Appeal. Written notice of the determination will be provided to You (or Your designee), designee and where appropriate, appropriate Your Provider, Provider within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 3 contracts

Samples: assets.ctfassets.net, assets.ctfassets.net, assets.ctfassets.net

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), ) and where appropriate, appropriate Your Provider, Provider within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 2 contracts

Samples: healthplex.com, healthplex.com

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), designee and where appropriate, appropriate Your Provider, Provider within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 1 contract

Samples: mydental.guardianlife.com

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Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within the earlier of 30 calendar days of receipt of the information necessary to conduct the Appeal or 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 1 contract

Samples: www1.deltadentalins.com

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We we will decide the Appeal within 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 1 contract

Samples: www.uhc.com

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), designee and where appropriate, appropriate Your Provider, Provider within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request...

Appears in 1 contract

Samples: dentalexchange.guardiandirect.com

Retrospective Appeal. If Your Appeal relates to a retrospective claim, We will decide the Appeal within 60 30 calendar days of receipt of the Appeal request. Written notice of the determination will be provided to You (or Your designee), and where appropriate, Your Provider, within two (2) business days after the determination is made, but no later than 60 calendar days after receipt of the Appeal request.

Appears in 1 contract

Samples: Subscriber Contract

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