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 DOC will review the recipient’s appeal and notify the recipient of the results in an Appeal Determination Letter.

  • EDA shall notify the Recipient of the results in an Appeal Determination Letter.

  • The Council will review the non-Federal entity’s appeal and notify the non-Federal entity of the results in an Appeal Determination Letter.

  • 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.

  • An Appeal Determination will be made within fifteen (15) working days from the date the request for appeal was made.

  • Timing of Appeal Determinations We will render a determination on pre-service appeals and post-service appeals as soon as practical, but in no event later than 30 days after the appeal has been received by Us. Notice of Appeal Determination We will notify the party filing the appeal, the Participant, and, if a clinical appeal, any health care provider who recommended the services involved in the appeal, by a written notice of the determination.

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

  • The Appeal Determination shall be a written decision and include the Appeal Officer’s rationale for the decision.

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

  • The Appeal Determination shall be sent to both parties simultaneously and the Appeal Officer’s decision is final at the School level.

Related to Appeal Determination

  • Final Determination means the final resolution of liability for any Tax for any taxable period, by or as a result of (i) a final and unappealable decision, judgment, decree or other order by any court of competent jurisdiction; (ii) a final settlement with the IRS, a closing agreement or accepted offer in compromise under section 7121 or section 7122 of the Code, or a comparable agreement under the laws of other jurisdictions, which resolves the entire Tax liability for any taxable period; (iii) any allowance of a refund or credit in respect of an overpayment of Tax, but only after the expiration of all periods during which such refund may be recovered by the jurisdiction imposing the Tax; or (iv) any other final disposition, including by reason of the expiration of the applicable statute of limitations.

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

  • Final Determination Date means the following:

  • Expert Determination the process described in Paragraph 6 of Schedule 8.3 (Dispute Resolution Procedure);

  • Appeal Tribunal means the all-citizen Tribunal duly appointed by Council to conduct hearings under this By-law; (191-08)

  • 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;

  • 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

  • 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 means 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 of Directors 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;¶

  • Flood Elevation Determination means a determination by the Administrator of the water surface elevations of the base flood, that is, the flood level that has a one percent or greater chance of occurrence in any given year.

  • 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;