Internal appeal or review definition

Internal appeal or review means an appellant's request for a carrier or health plan to review and reconsider an adverse benefit determination.
Sample 1Sample 2Sample 3
Internal appeal or review means the request by an appellant to a carrier or health plan to review and reconsider an adverse benefit determination.
Sample 1Sample 2

Related to Internal appeal or review

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

  • Governmental or Regulatory Authority means any court, tribunal, arbitrator, authority, agency, commission, official or other instrumentality of the United States, any foreign country or any domestic or foreign state, county, city or other political subdivision.

  • Internal audit means an independent appraisal activity established within a state agency as a control system to examine and evaluate the adequacy and effectiveness of other internal control systems within the agency.

  • Internal Auditor means the person employed or engaged by the Corporation to perform the internal audit function of the Corporation;

  • Internal dose means that portion of the dose equivalent received from radioactive material taken into the body.

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

  • External Auditor as used here shall mean any registered public accounting firm engaged for the purpose of preparing or issuing an audit report or performing other audit, review or attest services for the Company. Each such external auditor shall report directly to the Committee. With respect to the external auditor, the Committee shall:

  • Independent Safeguarding Authority is a non-departmental public body sponsored by the Home Office set up under the provisions of the Safeguarding Vulnerable Groups Act 2006 and which is responsible for the decision making and maintenance of two lists covering the children’s and vulnerable adults’ sectors

  • Competent Supervisory Authority means a supervisory authority which has jurisdiction in relation to the activities of a controller or processor under European data protection law in a particular Member State;

  • Mental or Nervous Disorder means any disease or condition, regardless of whether the cause is organic, that is classified as a Mental or Nervous Disorder in the current edition of International Classification of Diseases, published by the U.S. Department of Health and Human Services, is listed in the current edition of Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association or other relevant State guideline or applicable sources.

  • Principal or Representative means a principal, owner, partner, shareholder, joint venturer, investor, member, trustee, director, officer, manager, employee, agent, representative or consultant.

  • 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;

  • Appeal Board means the State Charter School Appeal

  • Michigan economic growth authority means the Michigan economic growth authority created in the Michigan economic growth authority act, 1995 PA 24, MCL 207.801 to 207.810.

  • investigating authority means an authority that in terms of national legislation may investigate unlawful activities;

  • 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.

  • NYPSC means the New York Public Service Commission.

  • Awarding Authority means a subordinate or component entity or person of the City (such as a City department or Board of Commissioners) that has the authority to enter into a contract or agreement for the provision of goods or services on behalf of the City of Los Angeles.

  • External dose means that portion of the dose equivalent received from any source of radiation outside the body.

  • EXPERIMENTAL OR INVESTIGATIONAL means any healthcare service that has progressed to limited human application, but has not been recognized as proven and effective in clinical medicine. See Experimental or Investigational Services in Section 3 for a more detailed description of the type of healthcare services we consider experimental or investigational.

  • 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;

  • MPSC means the Michigan Public Service Commission or its successor.

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

  • Highway authority means the state highway commission, a board of county road commissioners or the governing body of a city or village.

  • Permitting authority means the Iowa department of natural resources or the director thereof.

  • Internal Procedures means in respect of the making of any one or more entries to, changes in or deletions of any one or more entries in the register at any time (including without limitation, original issuance or registration of transfer of ownership) the minimum number of the Warrant Agent’s internal procedures customary at such time for the entry, change or deletion made to be complete under the operating procedures followed at the time by the Warrant Agent, it being understood that neither preparation and issuance shall constitute part of such procedures for any purpose of this definition;