Second Level UM Appeal Sample Clauses

Second Level UM Appeal. If the dispute or claim is still not resolved to Contractor’s satisfaction at the First Level UM Appeal level, Contractor may file a written Second Level UM Appeal, within thirty (30) calendar days following the date of the determination from the First Level UM Appeal, with the CCHCS Health Care Policy and Administration Director at the following address: Second Level UM Appeal California Correctional Health Care Services Health Care Policy and Administration Attn: Director P. O. Box 588500, Building D Elk Grove, CA 95758 This Second Level UM Appeal for Administrative Resolution shall include a written certification signed by a knowledgeable company official under the penalty of perjury according to the laws of the State of California pursuant to CCP § 2015.5 that the dispute, claim, or demand is made in good faith, and that the supporting data is accurate and complete. If an Agreement adjustment is requested, the written certification shall further state under penalty of perjury that the relief requested accurately reflects the Agreement adjustment for which CCHCS is responsible. The CCHCS Health Care Policy and Administration Director shall make a determination on the issue and respond in writing within thirty (30) State business days of receipt of the Second Level UM Appeal, indicating the written decision. Contractor shall be notified if an extension of time is necessary.
Sample 1
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