Notice of Adverse Benefit Determination definition

Notice of Adverse Benefit Determination means the notice must meet all requirements found at 42 CFR 438.44
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Notice of Adverse Benefit Determination and “NOABD” each has the meaning provided for in OAR 410- 141-3875.
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Notice of Adverse Benefit Determination means a notice that, per A.A.C. R9-34-205, explains:
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Examples of Notice of Adverse Benefit Determination in a sentence

  • The Contractor is required send out a Notice of Adverse Benefit Determination to the Enrollee and the Provider on the day that the timeframe expires.

  • Any Project Sponsor desiring a new interconnection or modification of an existing interconnection must provide the following applicable information: 1.

  • Contractor shall resolve the appeal as expeditiously as the beneficiary's health condition requires and no later than the date the extension expires (42 C.F.R. § 438.408(c)(2)(i)-(iii).) The written notice of the extension is not a Notice of Adverse Benefit Determination.

  • The Aggrieved Person may request an oral or written Appeal within 60 calendar days from the date on the Contractor’s written Notice of Adverse Benefit Determination.

  • The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time either the Enrollee or Provider informs the Contractor that the Provider failed to meet the performance standards for offering face-to- face appointment waiting times found in Article 10.4.

  • The Contractor shall provide a Notice of Adverse Benefit Determination to the Aggrieved Person at the time the Contractor determines the timeframe for resolving the Appeal or Grievance will not be met.

  • The Contractor shall also attach to the Notice of Adverse Benefit Determination a copy of the Medicaid State Fair Hearing request form that the Aggrieved Person can submit to request a State Fair Hearing.

  • The Contractor shall provide a written Notice of Adverse Benefit Determination to an Enrollee at the time of a decision to deny an Enrollee’s request to dispute financial liability, including as applicable cost sharing, copayments, premiums, deductibles, coinsurance and other Enrollee financial liabilities.

  • The Contractor shall provide a Notice of Adverse Benefit Determination to the Aggrieved Person at the time the Contractor determines the time frame for resolving the Appeal or Grievance will not be met.

  • The Contractor shall provide a Notice of Adverse Benefit Determination to the Enrollee at the time either the Enrollee or Provider informs the Contractor that the Provider failed to meet the performance standards found in Article 10.4 of this attachment for offering the first service.


More Definitions of Notice of Adverse Benefit Determination

Notice of Adverse Benefit Determination means a formal communication of any action and consistent with 42 CFR 438.404 and 438.10.
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Notice of Adverse Benefit Determination means a notice that,
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Notice of Adverse Benefit Determination means a written notice provided to the Member that explains the reasons for the Adverse Benefit Determination made by the AdSS regarding the service authorization request and includes the information required by this Policy.
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Related to Notice of Adverse Benefit Determination

  • Adverse Benefit Determination means any of the following:

  • 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 Adverse Determination means an Adverse Determination involving a Covered Service that has been upheld by Blue Cross and Blue Shield or its designated utilization review organization, at the completion of Blue Cross and Blue Shield's internal grievance process procedures.

  • Interest Determination Date means, with respect to a Rate of Interest and Interest Accrual Period, the date specified as such hereon or, if none is so specified, (i) the first day of such Interest Accrual Period if the Specified Currency is Sterling or (ii) the day falling two Business Days in London for the Specified Currency prior to the first day of such Interest Accrual Period if the Specified Currency is neither Sterling nor euro or (iii) the day falling two TARGET Business Days prior to the first day of such Interest Accrual Period if the Specified Currency is euro.