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.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by HMO at the completion of HMO’s internal review/appeal process.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by the Claim Administrator or, if applicable, your Employer, at the completion of the internal review/appeal process of an Adverse Benefit Determination with respect to which the internal review/appeal process has been deemed exhausted.
Examples of Final Internal Adverse Benefit Determination in a sentence
Type of Claim on Appeal Time Period for Notification of Final Internal Adverse Benefit Determination Urgent Care Claim No later than 72 hours from the date The Plan received the Member’s appeal, taking into account the medical exigency.
Time Period for Notifying Member of Final Internal Adverse Benefit Determination The time period for deciding an appeal of an adverse benefit determination and notifying the Member of the final internal adverse benefit determination depends upon the type of claim.
More Definitions of Final Internal Adverse Benefit Determination
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by the Claim Administrator or your Employer at the completion of the Claim Administrator's or Employer's internal review/appeal process.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by the Plan at the conclusion of the internal claims and appeals process, or an Adverse Benefit Determination with respect to which the internal claims and appeals process has been deemed exhausted.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by Blue Cross and Blue Shield at the completion of the Blue Cross and Blue Shield's internal review/appeal process.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by Us at completion of Our internal review/appeal process.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by the Claim Administrator at the completion of the Claim Administrator's internal review/appeal process.
Final Internal Adverse Benefit Determination means an adverse benefit determination that has been upheld by a health plan or carrier at the completion of the internal appeals process, or an adverse benefit determination with respect to which the internal appeals process has been exhausted under the exhaustion rules described in RCW 48.43.530 and 48.43.535.
Final Internal Adverse Benefit Determination means an Adverse Benefit Determination that has been upheld by the Plan at the completion of the internal review/appeal process.