Special Requirements for Appeals. The Contractor’s process for Appeals shall have only one level of review and shall: (1) provide that oral inquiries seeking an Appeal of an Adverse Benefit Determination are treated as an Appeal request; and (2) include as parties to the Appeal: (i) the Enrollee and the Enrollee’s representative, or (ii) the legal representative of a deceased Enrollee’s estate.
Appears in 7 contracts
Samples: Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract
Special Requirements for Appeals. (A) The Contractor’s process for Appeals shall have only one level of review and shall:
(1) provide Provide that oral inquiries seeking an Appeal of to appeal an Adverse Benefit Determination are be treated as an Appeal request; and
(2) include Include as parties to the Appeal:
(i) the Enrollee and the Enrollee’s their representative, or
(ii) the legal representative of a deceased Enrollee’s estateEstate.
Appears in 2 contracts
Samples: Managed Care Contract, Managed Care Contract
