Member Services Representative definition

Member Services Representative. An employee of HPN that is assigned to assist the Member or the Member’s Authorized Representative in appealing an Adverse Benefit Determination.
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Member Services Representative. An employee of SHL that is assigned to assist the Insured or the Insured’s Authorized Representative in appealing an Adverse Benefit Determination.
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Member Services Representative. An employee of HPN that is assigned to assist the Member or the Member’s Form No. HPN-Ind_AOC(2015) Page 28 Authorized Representative in appealing an Adverse Benefit Determination. A Formal Appeal must be submitted orally or in writing to HPN’s Customer Response and Resolution Department within 180 days of an Adverse Benefit Determination. Formal Appeals not filed in a timely manner will be deemed waived with respect to the Adverse Benefit Determination to which they relate. A Formal Appeal shall contain at least the following information: • The Member’s name (or name of Member and Member’s Authorized Representative), address, and telephone number; • The Member’s HPN membership number ; and • A brief statement of the nature of the matter, the reason(s) for the appeal, and why the Member feels that the Adverse Benefit Determination was wrong. Additionally, the Member may submit any supporting medical records, Physician’s letters, or other information that explains why HPN should approve the Claim for Benefits. The Member can request the assistance of a Member Services Representative at any time during this process. The Formal Appeals should be sent or faxed to the following: Health Plan of Nevada, Inc. Attn: Customer Response and Resolution Department P.O. Box 15645 NV017-3020 Las Vegas, NV 00000-0000 Fax: 0-000-000-0000 HPN will investigate the appeal. When the investigation is complete, the Member will be informed in writing of the resolution within thirty (30) days of receipt of the request for the Formal Appeal. This period may be extended one (1) time by HPN for up to fifteen (15) days, provided that the extension is necessary due to matters beyond the control of HPN and HPN notifies the Member prior to the expiration of the initial thirty (30) day period of the circumstances requiring the extension and the date by which HPN expects to render a decision. If the extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information and the Member shall be afforded at least forty-five (45) days from receipt of the notice to provide the information.
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Examples of Member Services Representative in a sentence

  • The Member can request the assistance of a Member Services Representative at any time during this process.

  • A Member Services Representative will return your call on the next business day.

  • The Canadian Nuclear Waste Management Organi- zation (NWMO) launched a mission to engage Cana- dians in debates and decision making on the future of Canada’s spent fuel.

  • The Insured can request the assistance of a Member Services Representative at any time during this process.

  • If auto coverage is provided through Catholic Mutual, contact should be made with your Member Services Representative.

  • Please consult your Member Services Representative at Catholic Mutual Group if you have any questions.

  • The Member Services Representative will inform the Member that upon review and investigation of the relevant information, HPN will make a determination of the Informal Review.

  • A Member Services Representative will explain the claims process to the Self-funded Member.

  • The Member, the prescriber, or the pharmacist must call Member Services and provide the information requested by the Member Services Representative.

  • Members may discuss personal issues with a Member Services Representative at the end of the meeting.

Related to Member Services Representative

  • Member Services are hereby defined as any products or services now or hereafter provided or sponsored by the Credit Union or otherwise made available to Credit Union members, which services include, but are not limited to: loans, deposit accounts, ATM services, online banking services, and other electronic fund transfer services.

  • Sales Representative means a person employed by, acting on

  • Supplier Representative means the representative appointed by the Supplier from time to time in relation to this Framework Agreement;

  • Contractor Representative means any of the following:

  • Customer Representative means the representative appointed by the Customer from time to time in relation to this Call Off Contract;

  • Supplier’s Representative means the representative appointed by the Supplier from time to time with overall responsibility for this Contract and notified to the Customer;

  • Authority’s Representative means the individual authorised to act on behalf of the Authority for the purposes of the Contract.

  • Principal’s Representative means the person nominated by the Principal or other person from time to time appointed in writing by the Principal to act as the Principal’s Representative for the purposes of the Contract.

  • Services Coordinator means an employee of the community developmental disability program or other agency that contracts with the county or Division, who is selected to plan, procure, coordinate, monitor Individual Support Plan services, and to act as a proponent for individuals with developmental disabilities.

  • Advisory representative means any Supervised Person, who in connection with his or her regular functions or duties, normally makes, participates in, or otherwise obtains current information regarding the Purchase or Sale of a Security by the Firm, or whose functions relate to the making of any recommendations with respect to such purchases or sales, and any natural Person in a Control relationship to the Firm who obtains information concerning recommendations made concerning a Purchase or Sale of a Security. This definition includes but is not limited to the following: partner, officer, Manager, investment person, Portfolio Manager and any other Supervised Person of the Firm designated as an “Advisory Representative” from time to time by the Review Officer.

  • Customer Service Representative means a person that provides an insurance service and insurance product information:

  • Procurement Representative means the person authorized by ULA’s cognizant procurement organization to administer and/or execute this Contract.

  • Contractor’s Representative means the individual authorised to act on behalf of the Contractor for the purposes of the Contract. The initial Contractor’s representative is as indicated in the Form of Agreement.

  • PJM Liaison means the liaison established under Tariff, Attachment M, section III.I.

  • Distributor representative means a representative employed by a distributor branch or distributor.

  • Project Manager means the principal employee or agent of the Recipient having administrative authority over the Project designated in Appendix B pursuant to Section VI hereof, or authorized designee as per written notification to the Director.

  • Program Manager refers to the professional management firm selected by the Owner as the Owner’s representative for the Project, and its employees and consultants.

  • Department Representative means the Manager, Engineering Operations, or designate, who shall represent the Landscape Operations Section for the purposes of this Agreement, or such other person who may be subsequently appointed in writing by the Department Representative and so notified to the Contractor;

  • Multiphase professional services contract means a contract for the providing of professional

  • Industry representative means an individual who is compensated by

  • Independent representative means a person who:

  • Management Representative means an individual designated to hear grievances on behalf of the University.

  • Emergency medical services provider means a person who has received formal training in prehospital and emergency care, and is licensed to attend any person who is ill or injured or who has a disability. Police officers, firefighters, funeral home employees and other persons serving in a dual capacity one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of this chapter.

  • Resident Representative means (if any) the individual (or, if permitted in accordance with the Companies Acts, the company) appointed to perform the duties of resident representative set out in the Companies Acts and includes any assistant or deputy Resident Representative appointed by the Board to perform any of the duties of the Resident Representative;

  • Non-Administrator Coordinated Home Care Program means a Coordinated Home Care Program which does not have an agreement with the Claim Administrator or a Blue Cross Plan but has been certified as a home health agency in accordance with the guidelines established by Medicare.

  • Project Representative means the individual(s), including but not limited to the Resident Engineer, to whom the Authority Representative has delegated Project responsibilities. If a Project Representative is appointed, the Project Representative represents the Authority Representative on the Project within the limits of that delegation with respect to any part of the Work.