Common use of Eligibility for External Appeal Clause in Contracts

Eligibility for External Appeal. An Enrollee is eligible for an external appeal when the Enrollee has exhausted the Contractor's internal utilization review procedure or both the Enrollee and the Contractor have agreed to waive internal appeal procedures in accordance with New York State P.H.L. Section 4914(2)2(a). A provider is also eligible for an external appeal of retrospective denials.

Eligibility for External Appeal. An Enrollee is eligible for an external appeal External Appeal when the Enrollee has exhausted the Contractor's internal utilization review procedure procedure, has received a final adverse determination from the Contractor, or both the Enrollee and the Contractor have agreed to waive internal appeal Appeal procedures in accordance with New York State P.H.L. Section PHL§ 4914(2)2(a). A provider is also eligible for an external appeal External Appeal of retrospective denials.

Eligibility for External Appeal. An Enrollee is eligible for an external appeal External Appeal when the Enrollee has exhausted received a final adverse determination from the Contractor for an expedited internal Action Appeal, has received a final adverse determination from the Contractor's internal utilization review procedure , or both the Enrollee and the Contractor have agreed to waive internal appeal Action Appeal procedures in accordance with New York State P.H.L. Section 4914(2)2(aPHL § 4914 (2) 2 (a). A provider is also eligible for an external appeal External Appeal of retrospective denials.

Eligibility for External Appeal. An Enrollee is eligible for an external appeal External Appeal when the Enrollee has exhausted the Contractor's internal utilization review procedure procedure, has received a final adverse determination from the Contractor, or both the Enrollee and the Contractor have agreed to waive internal appeal Appeal procedures in accordance with New York State P.H.L. PHL Section 4914(2)2(a). A provider is also eligible for an external appeal External Appeal of retrospective denials.

Eligibility for External Appeal. An Enrollee is eligible for an external appeal APPEAL when the Enrollee has exhausted HAS EXHAUSTED the Contractor's internal utilization INTERNAL UTILIZATION review procedure or both BOTH the Enrollee and and, the Contractor have agreed to waive internal appeal procedures in accordance with New York State P.H.L. P.H.L Section 4914(2)2(a). A provider PROVIDER is also eligible for an external appeal of retrospective denials.

Eligibility for External Appeal. An Enrollee is eligible for an external appeal when the Enrollee has exhausted the Contractor's internal utilization review procedure or both the Enrollee and the Contractor have agreed to waive internal appeal procedures in accordance with New York State P.H.L. P. H. L. Section 4914(2)2(a). A provider is also eligible for an external appeal of retrospective denials.