Formal Appeal definition

Formal Appeal. An appeal of an Adverse Benefit Determination filed either orally or in writing which HPN’s Customer Response and Resolution Department investigates. If a Formal Appeal is resolved to the satisfaction of the Member, the appeal is closed. The Formal Appeal is mandatory if the Member is not satisfied with the initial determination and the Member wishes to appeal such determination.
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Formal Appeal. An appeal of an Adverse Benefit Determination filed either orally or in writing which SHL’s Customer Response and Resolution Department investigates. If a Formal Appeal is resolved to the satisfaction of the Insured, the appeal is closed. The Formal Appeal is mandatory if the Insured is not satisfied with the Form No. SHL-Ind_AOC(2015) Page 27 Agreement of Coverage initial determination and the Insured wishes to appeal such determination.
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Examples of Formal Appeal in a sentence

  • Denied Pre-authorizations: You have 60 days from the date you receive notice that your denial was upheld at the Informal Reconsideration level to request a Formal Appeal.

  • You must send your request for a Formal Appeal in writing to the Appeals Coordinator at the above address.

  • As explained earlier, the SEE is a firm-level survey which before 2002 was based on an outdated sample of firms, and which only captures those working in the formal non-agricultural sector and in businesses whose turnover exceeds a certain threshold level.

  • If Cigna Dental upholds the denial, the notice will include a description of the criteria used, the clinical reasons for the decision, references to any supporting documentation, and notice of your right to proceed to a Formal Appeal.

  • It is now, September 2004, about two and a half years, halfway through the Life of Project.

  • A 2nd Level Formal Appeal not filed in a timely manner will be deemed waived with respect to the Adverse Benefit Determination to which it relates.

  • If Cigna Dental upholds the denial of a pre- authorization or a claim for services already providedat the Formal Appeal level, you may seek an External Independent Review.

  • If there is still no resolution, the student may file a Formal Appeal Step 2: Formal Appeal The Appeals Committee acts upon requests for exceptions to existing academic policies and requirements.

  • The Request for Formal Appeal must state the specific grounds for the appeal and the remedy(ies) requested.

  • When an Informal Review is not resolved in a manner that is satisfactory to the Member or when the Member chooses not to file an Informal Review and the Member wishes to pursue the matter further, the Member must file a 1st Level Formal Appeal.

Related to Formal Appeal

  • 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.

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

  • Formal Dispute means a written objection by an Interested Party to any of the following:

  • Formal complaint means a document filed by a complainant or signed by the Title IX Coordinator alleging sexual harassment against a respondent and requesting an investigation of the allegation of sexual harassment.

  • Formal hearing means a board or department process that provides for the right of private parties to submit factual proofs as provided in § 2.2-4020 of the Administrative Process Act in connection with case decisions. Formal hearings do not include the factual inquiries of an informal nature provided in § 2.2-4019 of the Administrative Process Act.

  • 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.

  • Final Approval Hearing means the hearing before the Court where the Parties will request the Final Judgment to be entered by the Court approving the Settlement Agreement, the Fee Award, and the incentive award to the Class Representative.

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

  • Final Approval Order means the order and final judgment approving the Settlement Agreement, implementing the terms of this Settlement Agreement, and dismissing the Class Action with prejudice, to be proposed by the Settling Parties for approval by the Court, in substantially the form attached as Exhibit 5 hereto.

  • 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.

  • Formal proceedings means proceedings conducted before a judge with notice to interested persons.

  • Final Approval means the Court’s order granting final approval of the Settlement.

  • Appeal Board means the State Charter School Appeal

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

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

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

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

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

  • 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.

  • Adjudicatory hearing means a hearing to determine:

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

  • Appeal Tribunal means the all-citizen Tribunal duly appointed by Council to conduct hearings under this By-law; (191-08)

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

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

  • Uniform Standards of Professional Appraisal Practice means the current standards of the appraisal profession, developed for appraisers and users of appraisal services by the Appraisal Standards Board of the Appraisal Foundation.