Claims and Appeals. The Contractor shall address claims for additional time or compensation under the Contract in writing to the Buyer and Project Manager within ten (10) Days of the date in which the Contractor knows or should know of the basis for the claim. Claims shall be accompanied by supporting documentation and citation to applicable provisions in the Contract documents. The County reserves the right to request additional documentation necessary to adequately review the claim. No claim by the Contractor shall be allowed if asserted after final payment under this Contract. The Buyer and Project Manager shall ordinarily respond to the Contractor in writing with a decision issued jointly, but absent such written response, the claim shall be deemed denied upon the tenth (10th) Day following receipt by the Buyer and Project Manager of the claim, or requested additional documentation, whichever is later. In the event the Contractor disagrees with the determination of the Buyer and Project Manager, the Contractor shall, within five (5) Days of the date of such determination, appeal the determination in writing to the Procurement and Payables Section Manager. Such written notice of appeal shall include all information necessary to substantiate the appeal. The Procurement and Payables Section Manager shall review the appeal and make a determination in writing, which shall be final. Appeal to the Procurement and Payables Section Manager on claims for additional time or compensation shall be a condition precedent to litigation. At all times, the Contractor shall proceed diligently with the performance of the Contract and in accordance with the direction of the Buyer or Project Manager. Failure to comply precisely with the time deadlines under this Section 8.1 as to any claim and appeal shall operate as a waiver and release of that claim and appeal and an acknowledgment of prejudice to the County.
Claims and Appeals. In the event of further developments, the UIPC may reconsider the VCR’s decision to retain intellectual property.
Claims and Appeals. 14 Initial Claims.............................................................................................................................. 14 Appeals....................................................................................................................................... 15 Other Rules and Rights Regarding Claims and Appeals............................................................ 16
Claims and Appeals. The Plan has specific procedures for making a claim for additional benefits. This claim and appeal process must be exhausted before you can file a lawsuit in court. The claim and appeal process has two levels: the initial claim and review on appeal. They operate as follows: Initial Claims
Claims and Appeals. The Organization shall have the right to lodge a complaint on proceeding of the process defined in § 1 including the right to lodge a complaint regarding work of auditors. Complaints shall be lodged according to the procedure provided on the website xxx.xxxx.xxx.xx. The Organization shall have the right to submit an appeal against a decision of the PCBC. Appeals shall be lodged according to the procedure provided on the website xxx.xxxx.xxx.xx. The principle of impartiality and confidentiality shall be observed at all stages of proceeding in processing complaints/appeals.
Claims and Appeals. A. Delta Dental will adjudicate and process all clean Claims submitted for Contractor’s Dental Plan, in accordance with this Contract, the Certificate and Delta Dental’s standard operating procedures.
Claims and Appeals. 43 Section 1 Claims Procedure 43 Section 2 Claim Denial. 44 Section 3 Claim Appeals 44 Section 4 Arbitration. 46
Claims and Appeals. The Seller will, upon the request of the Buyer, submit an appropriate claim to the Government, obtain a contracting officer decision or prosecute an appeal of any contracting officer decision with respect to any action taken or not taken by the Government under the Contract that in any way reduces or delays the payment of any Contract Payment or that, in the reasonable opinion of the Buyer, could adversely affect the Contract Payments.
Claims and Appeals. In the event a Participant or Beneficiary believes he or she is entitled to a payment from the Company which has not been made, he or she may submit a claim for benefits to the Administrative Committee. Any denial of the claim shall be made by the Administrative Committee in writing and shall specify the Plan provisions upon which the denial is based and any additional information or documentation which the Participant would need to submit to perfect his or her claim. The Participant may appeal in writing to the Administrative Committee any denial of his or her claim within 90 days following the denial, and shall include any additional information or documentation helpful to support his or her claim. The Administrative Committee's decision shall be made in writing within 90 days of receipt of the appeal and shall be final and binding on the Participant and the Company.
Claims and Appeals. The procedures for filing major medical claims are explained in Section 9. The claim processing and appeal procedures are explained in Section 17. Section 9 - How To File a Medical/Surgical and Major Medical Claim 9-1 Filing of Medical Claims Request a medical claim form from W.P.E.E. Insurance Trust Fund, 0 Xxx Xxxxx Xxxxxx, Xxxxx 000, Xxxxxxxxxx, XX 00000-0000; 412-432-1130 or 0 -000-000-0000. • A form must accompany all claims; • Use one claim form for each family member; • You must complete Box #1 through #12 at the top portion of the medical form. Box #13 must be signed or indicate “Signature on File” if the payment is to be submitted directly to the provider (also known as “Assignment of Benefits”); • The doctor or provider should complete Box #15 through #34 of the medical form, or attach a self-explanatory itemized bill including CPT procedure code(s) and an ICD-9 diagnosis code to the claim form; • Be sure all your answers to all questions on the claim form are complete and correct; • Include the original bill. Photocopies or faxed bills, unless approved by the claims administrator, will result in denial of the claim; • Statement of Account and Balance Forward Bills are acceptable for balance bills only; these must be originals. If payment is to be issued directly to the provider of service, Box #13 on a medical claim form must be signed or indicate “Signature on File”. Submit the claim form with the balance bill; • Canceled checks, cash register tapes, Highmark Blue Cross Blue Shield Explanation of Benefits, and denials are not bills and cannot be accepted; • Claims should be submitted at least every 2 months, however they MUST be submitted no later than 12 months from the end of the calendar year for which the benefits are payable; Example Date of service 01 -01-2007 must be submitted by 12-31-2008 Date of service 12-31-2007 must be submitted by 12-31-2008 • If the claim is the result of an accident, you will be required to fill out an Accident Claim Information Form and a Reimbursement/Subrogation Acknowledgment Agreement; • For durable medical equipment and prosthetic devices, a letter of medical necessity from the attending physician must accompany the claim. Included must be the rental fee purchase price for the equipment and the length of time the equipment will be required; and • When “Coordination of Benefits” is applicable (see Section 15), you must submit the Explanation of Benefits form from any other insurance carrier along with an it...
