Appeals Coordinator definition

Appeals Coordinator. The individual who manages a Member’s Appeal throughout the entire appeal process. Application. Health Options or the Marketplace application submitted for the purpose of securing health insurance from Health Options. Applied Behavior Analysis. The design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including the use of direct observation, measurement and functional analysis of the relations between environment and behavior. Balance Billing. When a Provider bills a Member for some or all of the remaining charges not paid by the Plan (this does not include Member Out-of-Pocket Costs). When there is an inadequate network, balance billing does not apply.

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Appeals Coordinator means the department staff responsible for receiving appeals, forwarding appeals to the hear- ing examiner, and working directly with the hearing examiner and board on administrative matters regarding an appeal.

Appeals Coordinator. The individual who manages a Member’s Appeal throughout the entire appeal process.

Examples of Appeals Coordinator in a sentence

In the event of a dispute or uncertainty regarding which decision is most favorable to the Member, the PH-MCO will submit the matter to DHS’ Grievance and Appeals Coordinator for review and resolution.
If you need to postpone the review meeting, please let your Appeals Coordinator know.
You or your Designee must tell your Appeals Coordinator if you wish to attend.
Said appeals shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Services.
You may also participate in the meeting by telephone or video conferencing if you wish – please let your Appeals Coordinator know.
If we need more information (such as medical records, bills, or other documents) to process your Appeal, your Appeals Coordinator will let you know.
You may contact an Alliant Complaints and Appeals Coordinator at the number listed on the acknowledgement letter or notice of Adverse Benefit Determination or Final Adverse Benefit Determination.
In the event of a dispute or uncertainty regarding which decision is most favorable to the member, the PH-MCO will submit the matter to DPW’s Grievance and Appeals Coordinator for review and resolution.
We will send you a letter acknowledging receipt of the Appeal and identifying your Appeals Coordinator within three business days after we receive your Appeal.
Said appeals shall be sent to the attention of the ASSURIA MEDISCHE VERZEKERING N.V. Appeals Coordinator, c/o Redbridge Network & Healthcare, Inc.

More Definitions of Appeals Coordinator

Appeals Coordinator means the person appointed by the Trustee as the coordinator to administer any appeal brought under these Rules. The authority and obligations of the Appeals Coordinator are provided in these rules. The duties of the Appeals Coordinator may be carried out through such other representatives as the Trustee may direct.

Appeals Coordinator means the person appointed under section 10 of this Bylaw.

Appeals Coordinator means the person responsible for coordinating the appeal. The Appeals Coordinator is a CPLED employee;

Appeals Coordinator means the State appointed person, not involved in the initial decision-making on the case, with the responsibility for the decision on appeals.