Appeals procedure definition

Appeals procedure means a formal process whereby a covered person, a representative of a covered person, or attending physician, facility or health care provider on a covered person’s behalf, can contest an adversehealth care treatment decision rendered by the health carrier or its designee utilization review entity (URE), which results in the denial, reduction without further opportunity for additional services or termination of coverage of a requested health care service.
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Appeals procedure. The Claims Appeal procedure is described in detail on the Consortium Website. The process begins with initial contact with Excellus or Pro-Act. The appeal can be made by the patient, patient representative, or service provider. If the internal appeal process is not satisfactory, a covered person is not satisfied with an appeal determination regarding a claim that does not relate to a medical necessity or experimental/investigational services denial, the covered person may request a claim review by the GTCMHIC Appeals Committee by filing a written request for a review.
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Appeals procedure. Any Tenant may appeal in writing to the Chair of the RGS Committee against a decision made against them by their Site Secretary or the Site Manager within three weeks, giving full reasons for the objection. This appeal will be heard by a sub-committee of appropriate committee members with no conflict of interest and the Tenant will be invited to bring their own supporter and / or witness.
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Examples of Appeals procedure in a sentence

  • A copy of the BFI’s Complaints and Appeals procedure can be obtained on request from the BFI’s Communications Office.

  • The Appeals procedure has two (2) levels, including review by a committee at the second level on an administrative Appeal and a review by an external Independent Review Organization (IRO) on a medical Appeal.

  • The executive director of the Iowa department of veterans affairs will approve or disapprove the application.13.9(3) Appeals procedure.

  • Before seeking the assistance of the Maryland Insurance Administration regarding the Appeal of a Coverage Decision, you must first exhaust Cigna Dental’s Level One Appeals procedure.

  • The Appeals procedure has two (2) levels, including review by a committee at the second level on an Administrative Appeal and a review by an external Independent Review Organization (IRO) on a Medical Appeal.

  • The application may be submitted to the department with name, address and telephone number, along with required document DD-214.1.11(3) Department processing and investigation.a. The time period for filing applications shall begin on July 1, 1999.b. The executive director of the department of veterans affairs will approve or disapprove the application.1.11(4) Appeals procedure.

  • In case of any dispute over the designation of a beneficiary, the dispute shall be resolved by the Fund subject to its Claims Review and Appeals procedure.

  • Appeals may be lodged only upon the deliverance of an adverse program decision regarding eligibility or closure of an application, and only within the parameters set by the Appeals procedure.

  • The executive director of the Iowa department of veterans affairs will approve or disapprove the application.16.7(3) Appeals procedure.

  • The Appeals procedure has two (2) internal, administrative levels, including review by a committee at the second level.


More Definitions of Appeals procedure

Appeals procedure. As 3(b) above
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Appeals procedure means a formal process whereby a covered
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Appeals procedure means a formal process whereby a covered person, a representative of a covered person, attending physician, facility or health care provider can contest an adverse determination rendered by the health carrier or its designee utilization review organization, which results in the denial, reduction or termination of a requested health care service.
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Appeals procedure means the process by which an applicant can appeal a decision of the Board in relationship to membership of the Institute.
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Related to Appeals procedure

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

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

  • Dispute Resolution Procedure means the procedure for resolution of Disputes set forth in Article 26;

  • Appeals Board means the commissioners and deputy commissioners of the Workers’ Compensation Appeals Board acting en banc, in panels, or individually.

  • Dispute Resolution Procedures means the procedures outlined in Annexure A of the MSA Determination.

  • Claims Administration means the processing of claims made under the Shared Policies, including the reporting of claims to the insurance carriers, management and defense of claims and providing for appropriate releases upon settlement of claims.

  • Appeal Board means the State Charter School Appeal

  • Dispute Resolution Process means the process described in clause 9

  • Claims Administrator means the firm proposed by Class Counsel and appointed by the Courts to administer the Settlement Amount in accordance with the provisions of this Settlement Agreement and the Distribution Protocol, and any employees of such firm.