Appeal Determination definition

Appeal Determination means a determination by Delta Dental of New York’s Dental Affairs Committee that a health care service, upon review based on the information provided, is not medically necessary.
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Appeal Determination means a determination by the Refugee Appeals Authority in accordance with section 8C(2) of the Act, either based on oral evidence following an inquisitorial process, or determined on the papers comprising the application for appeal, or both;
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Examples of Appeal Determination in a sentence

  • The Plan will provide or transmit all necessary documents and information considered in making the Adverse Benefit Determination or First Level Appeal Determination to the assigned IRO electronically or by telephone or facsimile or any other available expeditious method.

  • The Appeal Determination shall address the required Determination elements previously set forth in these procedures.

  • Delta Dental shall advise the Enrollee and the attending dentist of the Appeal Determination within two (2) days of the rendering of such determination.

  • TakeCare will appoint an individual at TakeCare to provide you with an Internal Appeal Determination (whether adverse or not), taking into account the medical exigencies, not later than seventy-two (72) hours after receipt of your appeal by TakeCare.

  • UnitedHealthcare Vision Attn: Reconsideration ReviewP.O. Box 30978Salt Lake City, UT 84130Reconsideration review requests must be in writing and received by UnitedHealthcare Vision within 60 days after your receipt of the Notice of Benefit Appeal Determination.

  • Upon receipt of notice of an Expedited External Appeal Decision reversing the Adverse Benefit Determination or Internal Appeal Determination, TakeCare immediately must provide coverage or payment (including immediately authorizing or immediately paying benefits) for the claim regardless of whether TakeCare intends to seek judicial review of the External Review Decision and unless or until there is a judicial decision otherwise.

  • Upon receipt of notice of an External Appeal Decision revers- ing the Adverse Benefit Determination or Internal Appeal Determination, TakeCare immediately must provide coverage or payment (including immediately authorizing or immedi- ately paying benefits) for the claim, regardless of whether TakeCare intends to seek judicial review of the External Review Decision and unless or until there is a judicial decision otherwise.

  • The External Appeal of an Adverse Benefit Determination of an Internal Appeal Determination may be initiated by sending the Request for External Appeal form which is attached to the Notice of Denial of Internal Appeal.

  • Upon written request by a Claimant, TakeCare will deliver written notice of the Internal Appeal Determination to the Claimant electronically or by facsimile.

  • The CMTPC concurred with staff’s suggestion and offered additional technicaladvice on the employment of these methods at its meeting on November 3, 2005.

Related to Appeal Determination

  • Final Determination means a determination within the meaning of Section 1313 of the Code or any similar provision of state or local Tax Law.

  • Initial determination means the first child custody determination concerning a particular child.

  • Final Determination Date means the following:

  • Expert Determination has the meaning given to it in Clause 18.3(a) (Expert Determination).

  • Appeal Tribunal means the all-citizen Tribunal duly appointed by Council to conduct hearings under this By-law; (200-08)

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Appeals Tribunal or “AT” means the Body responsible for hearing and determining appeals set out in section 9;

  • Benchmark Determination Date means (a) if the Benchmark is LIBOR, the LIBOR Determination Date, (b) if the Benchmark is Term SOFR, the date that is two Business Days before the first day of the applicable Accrual Period, (c) if the Benchmark is Compounded SOFR, the date that is five Business Days before the last day of the applicable Accrual Period and (d) if the Benchmark is any other rate, the date determined by the Trust according to Section 2.16 of the Indenture.

  • Reviewing Authority means the Alberta Securities Commission.

  • Self-Determination means a philosophy and process by which individuals with developmental disabilities are empowered to gain control over the selection of support services that meet their needs. The basic principles of self-determination are:

  • Adverse determination shall have the meaning set forth in Section 19.7.

  • Event Determination Date means either:

  • Administrative merits determination means certain notices or findings of labor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

  • Adverse Benefit Determination means any of the following:

  • Appeal Board means the State Charter School Appeal

  • TIA Applicability Determination As defined in Section 12.12.

  • Appeal Panel means a panel comprised of a chair and two individuals appointed by the Board to consider appeals under Chapter 7.

  • SOFR Determination Date has the meaning specified in the definition of “Daily Simple SOFR”.

  • Determination means the written documentation of a decision of a procurement officer including findings of fact required to support a decision. A determination becomes part of the procurement file to which it pertains.

  • Reviewing Party any appropriate person or body consisting of a member or members of the Company's Board of Directors or any other person or body appointed by the Board who is not a party to the particular Claim for which Indemnitee is seeking indemnification, or Independent Legal Counsel.

  • Appeal Committee means the appeal committee established by the Council in terms of section 12(3)(a);

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Appeal means a request for a review of the Floodplain Administrator's interpretation of any provision of this ordinance.

  • Index Determination Date means, in relation to any Index, a date on which such Indexfalls to be determined in accordance with the Conditions;

  • SOFR Determination Time means 3:00 p.m. (New York time) on the U.S. Government Securities Business Day, at which time Compounded SOFR is published on the FRBNY’s Website.

  • Appeal authority means the executive authority of the municipality or any other body or institution outside of the municipality authorised by that municipality to assume the obligations of an appeal authority for purposes of appeals lodged in terms of the Act;