Appeal decision definition

Appeal decision means a final determination made by us that arises from an appeal filed with us under our appeal process regarding a coverage decision concerning a Covered person.

Appeal decision means final determination by the Plan that arises from an Appeal.

Appeal decision means a final determination made by us that arises from an appeal filed with us under our appeal process regarding a coverage decision concerning a Covered Person.

Examples of Appeal decision in a sentence

• The administrative Appeal decision will be mailed to the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf, within thirty (30) days of receipt of the Member’s request; unless it is mutually agreed that an extension of time is warranted.

• Requests submitted to Us after sixty (60) days of Our first level Appeal decision will not be considered.

• The Plan Manager will notify the covered person, authorized person, or provider of the Internal Appeal decision on the Adverse Determination within thirty (30) calendar days of receipt of the Internal Appeal request by the Plan Manager.

• The Council is part of the Federal government.● If the answer is yes, or if the Council denies our request to review a favorable Level 3 Appeal decision, the appeals process may or may not be over — We will decide whether to appeal this decision to Level 5.

• We may wait for the Level 4 Appeal decision before authorizing or providing the service in dispute.● If the Administrative Law Judge or attorney adjudicator says no to your appeal, the appeals process may or may notbe over.○ If you decide to accept this decision that turns down your appeal, the appeals process is over.○ If you do not want to accept the decision, you can continue to the next level of the review process.

More Definitions of Appeal decision

Appeal decision means a written or electronic notice in response to an appeal under this chapter provided to a contracted pharmacy that includes a reason for the appeal denial.

Appeal decision means a final determination by Delta Dental that arises from an Appeal filed with Delta Dental under our appeal process regarding a Coverage Decision concerning an Enrollee.

Appeal decision means a final determination by a carrier that arises from an appeal filed with the carrier under its appeal process regarding a coverage decision concerning a member.

Appeal decision means a final determination by us after a review of an appeal regarding a coverage decision. “Compelling Reason” means a showing that the potential delay in receipt of a health care service until after

Appeal decision means a written or electronic notice issued by a PBM in response to an appeal filed by a contracted pharmacy of the maximum allowable cost used to adjudicate a claim.

Appeal decision means the decision made by the Planning Inspectorate in relation to the Appeal

Appeal decision. A final determination by the Health Plan that arises from an Appeal filed with the Health Plan under its internal Appeal process regarding a Coverage Decision concerning a Member.