Appeal of adverse determination definition

Appeal of adverse determination means the formal process by which a utilization review agent offers a mechanism to address adverse determinations as defined in Article 21.58A, Texas Insurance Code. Auxiliary aids and services includes qualified interpreters or other effective methods of making aurally delivered materials understood by persons with hearing impairments; and, taped texts, large print, Braille, or other effective methods to ensure visually delivered materials are available to individuals with visual impairments. Auxiliary aids and services also includes effective methods to ensure that materials (delivered both aurally and visually) are available to those with cognitive or other disabilities affecting communication. Benchmark means a target or standard based on historical data or an objective/goal. 1999 Renewal Contract Bexar Service Area August 9, 1999
Sample 1
Appeal of adverse determination means the formal process by which a utilization review agent offers a mechanism to address adverse determinations as defined in Article 21.58A, Texas Insurance Code.
Sample 1
Appeal of adverse determination means the formal process by which a utilization review agent offers a mechanism to address adverse determinations as defined in Article 21.58A, Texas Insurance Code. Auxiliary aids and services includes qualified interpreters or other effective methods of making aurally delivered materials understood by persons with hearing impairments; and, taped texts, large print, Braille, or other effective methods to ensure visually delivered materials are available to individuals with visual impairments. Auxiliary aids and services also includes effective methods to ensure that materials (delivered both aurally and visually) are available to those with 1999 Renewal Contract Harrxx Xxxvice Area 9 August 9, 1999 cognitive or other disabilities affecting communication. Benchmark means a target or standard based on historical data or an objective/goal.
Sample 1

Examples of Appeal of adverse determination in a sentence

  • NAC 287.670 - Appeal of adverse determination: Requirements; duties of Appeals Manager (NRS 287.043).

  • Appeal of adverse determination regarding pre-existing nonconforming status of gravel strip.

  • Rule 4.47 Appeal of adverse determination of moral character issued by Committee (A) If the Committee issues An applicant notified of an adverse determination of moral character, an applicant may file a request for hearing on the determination with the State Bar Court in accordance with the Rules of Procedure of the State Bar on Moral Character Proceedings.

  • The Board will attempt to provide records in the format requested by the requester.§ 261.14 Appeals.(a) Appeal of adverse determination.


More Definitions of Appeal of adverse determination

Appeal of adverse determination means the formal process by which a utilization review agent offers a mechanism to address adverse determinations as defined in Article 21.58A, Texas Insurance Code. Auxiliary aids and services includes qualified interpreters or other effective methods of making aurally delivered materials understood by persons with hearing impairments; and, taped texts, large print, Braille, or other effective methods to ensure visually delivered materials are available to individuals with visual impairments. Auxiliary aids and services also includes effective methods to ensure that materials (delivered both aurally and visually) are available to those with cognitive or other disabilities affecting communication. 1999 Renewal Contract Tarrant Service Area 9 August 9, 1999 10 disorders and treatment of chemical dependency disorders. Benchmark means a target or standard based on historical data or an objective/goal.
Sample 1
Appeal of adverse determination means the format process by which a utilization review agent offers a mechanism to address adverse determination as defined in Article 21.58A, Texas Insurance Code. Auxiliary aids and services includes qualified interpreters or other effective methods of making aurally delivered materials understood by persons with hearing impairments; and, taped texts, large print, Braille, or other effective methods to ensure visually delivered materials are available to individuals with visual impairments. Auxiliary aids and services also includes effective methods to ensure that materials (delivered both aurally and visually) are available to those with cognitive or other disabilities affecting communication. Behavioral health services means covered services for the treatment of mental or emotional disorders and treatment of chemical dependency disorders. Benchmark means a target or standard based on historical data or an objective/goal.
Sample 1

Related to Appeal of adverse determination

  • Final Adverse Determination means an Adverse Determination involving a Covered Service that has been upheld by Blue Cross and Blue Shield or its designated utilization review organization, at the completion of Blue Cross and Blue Shield's internal grievance process procedures.

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

  • Adverse decision means any decision by a review agent not to certify an admission,

  • Final Adverse Benefit Determination means an adverse benefit determination that is upheld at the completion of a health plan issuer’s internal appeals process.

  • Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by BCBSTX at the completion of BCBSTX’s internal review/appeal process.

  • Adverse Benefit Determination means any of the following:

  • 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.

  • 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:

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

  • 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.

  • TIA Applicability Determination As defined in Section 12.12.

  • Standard of Conduct Determination shall have the meaning ascribed to it in Section 9(b) below.

  • Reviewing Authority means the Alberta Securities Commission.

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

  • Final Adjudication has the meaning set forth in Section 5.5.

  • 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.

  • Company Adverse Recommendation Change shall have the meaning set forth in Section 5.3(c).

  • Final Decision means a final action of the commission determining the legal rights, duties, or privileges of any person. “Final decision” does not include preliminary, procedural, or intermediate actions by the commission, actions regulating the internal administration of the commission, or actions of the commission to enter into or refrain from entering into contracts or agreements with vendors to provide goods or services to the commission.

  • key decision * means an executive decision which is likely to:

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

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

  • Serious Adverse Event means any adverse event that led to any of the following:

  • 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 Board means the State Charter School Appeal

  • Third party claimant means any individual, corporation, association, partnership, or other legal entity asserting a claim against any individual, corporation, association, partnership, or other legal entity insured under an insurance policy or insurance contract.

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