BOH Appeal definition

BOH Appeal a written request to the BOH, made by an Enrollee or Appeal Representative to review the correctness of a Final Internal Appeal decision by the Contractor.
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Examples of BOH Appeal in a sentence

  • If you want to get Continuing Services during the BOH Appeal process, you must file your BOH Appeal within 10 calendar days from the date of our letter to you that explained our decision on your Appeal.

  • Covered Services that were previously authorized by the Contractor and are the subject of an internal Appeal or Board of Hearings (BOH) Appeal, if applicable, involving a decision by the Contractor to terminate, suspend, or reduce the previous authorization and which are provided by the Contractor pending the resolution of the internal Appeal or BOH Appeal, if applicable.

  • In any event, we will approve the services no later than 72 hours from the date we receive BOH notice that it reversed our decision.• If you receive “Continuing Services” while the BOH Appeal was happening, we will pay for those services.

  • Please note: if you file between 21 and 120 calendar days from the date of our Internal Appeal decision, the BOH will process your External Appeal within their standard timeframe.The letter we send you telling you our Internal Appeal decision will include the form (and other information) you will need to file your request for an External Appeal with the BOH if you choose to file one.After your BOH Appeal is filed, you will receive a free copy of your case file before the hearing.

  • MCO Covered Services that were previously authorized by the Contractor and are the subject of an Internal Appeal or BOH Appeal, if applicable, involving a decision by the Contractor to terminate, suspend, or reduce the previous authorization and which are provided by the Contractor pending the resolution of the Internal Appeal or BOH Appeal, if applicable.

  • ACO Covered Services that were previously authorized by the Contractor and are the subject of an Internal Appeal or BOH Appeal, if applicable, involving a decision by the Contractor to terminate, suspend, or reduce the previous authorization and which are provided by the Contractor pending the resolution of the Internal Appeal or BOH Appeal, if applicable.

  • Appeal Representative – any individual that the Contractor can document has been authorized by the Enrollee in writing to act on the Enrollee’s behalf with respect to all aspects of a Grievance, Internal Appeal, or BOH Appeal.

  • If your BOH Appeal involves a decision by us or by Beacon to change a service that we authorized in the past, including a decision to reduce, suspend, or end a service, you can choose to continue getting the requested services during the BOH Appeal process.

  • Whenever an Enrollee submits a written request for a BOH Appeal within ten calendar days of the date of mailing of the Contractor’s internal Appeal decision, the Contractor is responsible for the continued authorization or provision of any ongoing service in dispute during the pendency of a BOH Appeal.

  • If your BOH Appeal involves a decision by us or by Beacon to change a service that weauthorized in the past, including a decision to reduce, suspend, or end a service, you can choose to continue getting the requested services during the BOH Appeal process.

Related to BOH Appeal

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

  • Appeal Board means the State Charter School Appeal

  • Board of appeals means the local board of appeals as created by local ordinance.

  • Court of Appeal means the division of the Supreme Court referred to in section 7(1)(b);

  • Expedited Appeal means if a Member appeals a decision regarding a denied request for Prior Authorization (Pre-Service Claim) for an Urgent Care Claim, the Member or Member’s Authorized Representative can request an Expedited Appeal, either orally or in writing. Decisions regarding an Expedited Appeal are generally made within seventy-two (72) hours from the Plan’s receipt of the request.

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

  • Reconsideration means review by the director of an insurer’s Notice of Closure.

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

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

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

  • Appeals Panel means a panel appointed by the Chief Compliance Officer pursuant to Rule 620.

  • Division of hearings and appeals means the division of hearings and appeals in the department of administration.

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

  • Review Board has the meaning provided in Section 2.1(f)(i) of this Commercial Shared-Loss Agreement.

  • Appeals Committee means a Committee or Tribunal duly appointed by by-law to conduct hearings under this By-law;

  • Notice of Appeal means a notice given pursuant to Condition 6.2.

  • Successful Respondent means an organization that receives a grant award as a result of this RFA. May also be referred to as "Grantee, ""Awarded Applicant," "Subrecipient" or "Grant Recipient."

  • Decision means a determination, action, vote, or disposition upon a motion, proposal, recommendation, resolution, order, ordinance, bill, or measure on which a vote by members of a public body is required and by which a public body effectuates or formulates public policy.

  • Hearing means an oral hearing and includes a hearing conducted in whole or in part by video link, telephone or other means of instantaneous two-way electronic communication;

  • Successful Applicant means an “employee applicant” or “applicant” who has been offered employment within this Bargaining Unit by the Employer.

  • Adjudicating Authority or “NCLT” shall mean the Hon’ble Chennai Bench of the National Company Law Tribunal;

  • Final Approval Order and Judgment means the order in which the Court certifies the Settlement Class, grants final approval of this Settlement Agreement, authorizes the entry of a final judgment, and dismisses the Action with prejudice.

  • Internal appeal means an internal appeal to the relevant authority in terms of section 74;

  • Claimant means a person or entity who or which submits a Claim Form to the Claims Administrator seeking to be eligible to share in the proceeds of the Settlement Fund.

  • 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;

  • Final Order and Judgment means the final judgment and order of dismissal with prejudice to be entered in the Lawsuit in connection with the approval of the Settlement after the Final Approval Hearing.