Expedited Medical Necessity Appeal Sample Clauses

Expedited Medical Necessity Appeal. An Expedited Appeal process is available to review a Medical Necessity Appeal involving an urgent care claim. An urgent care claim is a claim where the application of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the claimant to regain maximum function, or, in the opinion of a Provider with knowledge of the claimant’s condition, would subject the claimant to severe pain that cannot be adequately managed without the care or treatment that is subject to the claim. An Expedited Appeal shall be made available to, and may be initiated by the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf. Requests for an Expedited Appeal may be verbal or written. For verbal Expedited Appeals, call 0-000-000-0000 or 0-000-000-0000. For written Expedited Appeals, mail to: Xxxxx Vision Quality Assurance Department P. O. Box 791 Latham, NY 12110 Xxxxx Vision will make a decision no later than seventy-two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance with any Appeal issues at the following address and phone numbers:‌‌‌‌ Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 ERISA RIGHTS To the extent this is an ERISA plan, the Member is entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). For purposes of this provision, the Group is considered the Plan Administrator and will be subject to the provisions stated below. ERISA provides that all Plan Participants (Members) shall be entitled to: Receive Information About the Plan and Benefits A Member may examine, without charge, at the plan administrator’s office and at other specified locations, such as worksites and union halls, all documents governing the plan, including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the United States Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Upon written request to the plan administrator, a Member may obtain copies of documents governing the operation of the plan, including any applicable insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The plan administrator...
Sample 1
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Expedited Medical Necessity Appeal. An Expedited Appeal process is available to review a Medical Necessity Appeal involving an urgent care claim. An urgent care claim is a claim where the application of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the claimant to regain maximum function, or, in the opinion of a Provider with knowledge of the claimant’s condition, would subject the claimant to severe pain that cannot be adequately managed without the care or treatment that is subject to the claim. An Expedited Appeal shall be made available to, and may be initiated by the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf. Requests for an Expedited Appeal may be verbal or written. For verbal Expedited Appeals, call 0-000-000-0000 or 0-000-000-0000. For written Expedited Appeals, mail to:‌‌‌ Xxxxx Vision Quality Assurance Department P. O. Box 791 Latham, NY 12110 Xxxxx Vision will make a decision no later than seventy -two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance with any Appeal issues at the following address and phone numbers: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000
Sample 1
Expedited Medical Necessity Appeal. An Expedited Appeal process is available to review a Medical Necessity Appeal involving an urgent care claim. An urgent care claim is a claim where the application of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the claimant to regain maximum function, or, in the opinion of a Provider with knowledge of the claimant’s condition, would subject the claimant to severe pain that cannot be adequately managed without the care or treatment that is subject to the claim. An Expedited Appeal shall be made available to, and may be initiated by the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf. Requests for an Expedited Appeal may be verbal or written. For verbal Expedited Appeals, call 0-000-000-0000 or 0-000-000-0000. For written Expedited Appeals, mail to: Xxxxx Vision Quality Assurance Department
Sample 1

Related to Expedited Medical Necessity Appeal

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  • Expedited Arbitrations Where a difference arises at an institution relating to the interpretation, application or administration of a local agreement, including where an allegation is made that a term or condition of a local agreement has been violated, either of the local parties may, after exhausting the steps of the grievance procedure under the local agreement, notify the other local party within ten (10) calendar days of receipt of the last grievance step reply, of its desire to arbitrate and to submit the difference or allegation to expedited arbitration before a single arbitrator.

  • LABOR/MANAGEMENT COMMITTEES Section 1. Labor/Management Committees The parties recognize that the holding of periodic meetings for the exchange of views and information contributes to the effectiveness of the labor/management relationship. Therefore, the parties shall establish Labor/Management Committees (LMC), in accordance with the provisions in this Article, for the purpose of addressing matters of concern in the areas of personnel policies, practices, conditions of employment, and other matters affecting employees. Each LMC will be co-chaired by one member from labor and one member from management.

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