Fee of filing Appeal. (a) Fee of first appeal shall be rupees two thousand five hundred and for second appeal shall be rupees ten thousand, which shall be non-refundable.
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Legal Appeals a. Nothing contained in these provisions is intended to limit or impair the rights of any vendor or Contractor to seek and pursue remedies of law through the judicial process. Appendix C Appendix C, Contract Modification Procedure, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. Appendix D Appendix D, Pricing Schedules, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. The Parties expressly agree that these prices are established as “maximum Not-To-Exceed prices”. The Contractor acknowledges that any mini-bid under this Centralized Contract which includes pricing in excess of the “maximum Not-To-Exceed price” shall be rejected by the Authorized User. Amendments to Appendix D, Pricing Schedules, shall be processed in accordance with Appendix C, Contract Modification Procedure, section 4.8, OGS Centralized Contract Modifications and section 4.23 Price Adjustments for OGS Centralized Contracts. Appendix E Appendix E, Report of Contract Purchases, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to make unilateral changes to this Report of Contract Purchases document. Appendix F Appendix F, Project Based Information Technology Consulting Services Processes and Forms, attached hereto, is hereby expressly made a part of this Contract as fully as if set forth at length herein. OGS reserves the right to change the processes and forms set forth Appendix F in non-material and substantive ways without seeking a contract amendment. Appendix F is comprised of the following attachments:
Reconsiderations and Appeals If you experience a problem relating to an authorization review, benefit denial, or other aspect of this plan, we have internal and external procedures to help you resolve your issue. The following sections detail the processes and procedures for filing: • Administrative Appeals; • Medical Reconsiderations and Appeals (including expedited appeals); • Prescription Drug Appeals: and
Time Limit for Filing The parties may mutually agree in writing to extend any of the time limits set forth in this Agreement.
How to File an Appeal of a Prescription Drug Denial For denials of a prescription drug claim based on our determination that the service was not medically necessary or appropriate, or that the service was experimental or investigational, you may request an appeal without first submitting a request for reconsideration. You or your physician may file a written or verbal prescription drug appeal with our pharmacy benefits manager (PBM). The prescription drug appeal must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. You will receive written notification of our determination within thirty (30) calendar days from the receipt of your appeal. How to File an Expedited Appeal Your appeal may require immediate action if a delay in treatment could seriously jeopardize your health or your ability to regain maximum function, or would cause you severe pain. To request an expedited appeal of a denial related to services that have not yet been rendered (a preauthorization review) or for on-going services (a concurrent review), you or your healthcare provider should call: • our Grievance and Appeals Unit; or • our pharmacy benefits manager for a prescription drug appeal. Please see Section 9 for contact information. You will be notified of our decision no later than seventy-two (72) hours after our receipt of the request. You may not request an expedited review of covered healthcare services already received.
Decision and Appeal Within five school business days after receiving the Complaint Manager’s report, the Superintendent shall mail his or her written decision to the Complainant and the accused by first class U.S. mail as well as to the Complaint Manager. All decisions shall be based upon the preponderance of evidence standard. Within 10 school business days after receiving the Superintendent’s decision, the Complainant or the accused may appeal the decision to the Board by making a written request to the Complaint Manager. The Complaint Manager shall promptly forward all materials relative to the complaint and appeal to the Board. Within 30 school business days, the Board shall affirm, reverse, or amend the Superintendent’s decision or direct the Superintendent to gather additional information. Within five school business days after the Board’s decision, the Superintendent shall inform the Complainant and the accused of the Board’s action. For complaints containing allegations involving the Superintendent or Board member(s), within 30 school business days after receiving the Complaint Manager’s or outside investigator’s report, the Board shall mail its written decision to the Complainant and the accused by first class U.S. mail as well as to the Complaint Manager. This policy shall not be construed to create an independent right to a hearing before the Superintendent or Board. The failure to strictly follow the timelines in this grievance procedure shall not prejudice any party.
Filing of Claims You must file all Claims within ninety (90) days from the date services were rendered, unless it is not reasonably possible to do so. In no event may any Claim be filed later than fifteen (15) months from the date services were rendered. Claims Administrator and Participating Providers have entered into agreements that eliminate the need for a Member to personally file a Claim for Benefits. Participating Providers will file Claims for Members either by mail or electronically. In certain situations, the Provider may request the Member to file the Claim. If Your Provider does request You to file directly with the Company, the following information will help You in correctly completing the Claim form. We will, upon receipt of a notice of claim, furnish to You such forms as are usually furnished by Us for filing proofs of loss. If such forms are not furnished within fifteen (15) days after the giving of such notice, You will be deemed to have complied with the requirements of this Contract as to proof of loss upon submitting, within the time fixed in this Contract for filing proofs of loss, any affirmative written proof covering the occurrence, the character and the extent of the loss for which the claim is made. If You have any questions about any of the information in this section, You may call Your insurance agent or Our Customer Service Department at the number shown in Your ID Card. Your Blue Cross and Blue Shield of Louisiana ID Card shows the way Your name appears on the Company records. (If You have Dependent coverage, the name(s) are recorded as You wrote them on Your application card.) The ID Card also lists Your Contract number (ID #). This number is the identification to Your Membership records and should be provided to Us each time a Claim is filed. To assist in promptly handling Your Claims, please be sure that: an appropriate Claim form is used the Contract number (ID #) shown on the form is identical to the number on the ID Card the patient's date of birth is listed the patient's relationship to the Subscriber is correctly stated all charges are itemized in a statement from the Provider the itemized statement from the Provider contains the Provider’s name, address and tax ID number and is attached to the Claim form the date of service (Admission to a Hospital or other Provider) or date of treatment is correct the Provider includes a diagnosis code and a procedure code for each service/treatment rendered the claim is completed and signed by the Member. If You need to submit documentation to Us, please sent it to: United Concordia Dental ATTN: Claims Department P.O. Box 69441 Harrisburg, PA 17106-9441
TYPE OF FILING NOTE Parties making multiple requests (such as seeking to adopt a previously approved Agreement and Commission approval of new negotiated amendments to that agreement) should submit a separate checklist for each requested action. ☐ Adoption: Adopts existing carrier-to-carrier agreement approved by the Commission. • Docket ARB ☐■ • Parties to prior agreement: & New Agreement: Seeks approval of a new negotiated agreement. Does adoption or agreement replace an existing agreement between the parties? ☐■ NO ☐ YES, Docket ARB ☐ Amendment: Amends an existing carrier to carrier agreement. Docket ARB Does this filing replace an agreement or amendment currently pending Commission approval? ☐■ NO ☐ YES, Docket ARB , Filed on Attachment(s) provided on CD, DVD or flash drive. FM906 2/2015 Print Commercial Mobile Radio Services (CMRS) By and Between United Telephone Company of the Northwest d/b/a CenturyLink and Charge Communication Inc. For the State of Oregon TABLE OF CONTENTS ARTICLE I. DEFINITIONS 5 1. GENERAL RULES 5 2. DEFINITIONS 5 ARTICLE II. GENERAL TERMS AND CONDITIONS 17 3. APPLICATION OF THESE GENERAL TERMS AND CONDITIONS 17 4. POSITION OF THE PARTIES 17 5. REGULATORY APPROVALS 17 6. EFFECTIVE DATE, TERM AND TERMINATION 17 7. CARRIER CERTIFICATION 20 8. APPLICABLE LAW 20 9. CHANGES IN LAW 21 10. AMENDMENTS 22 11. ASSIGNMENT 23 12. CONFIDENTIAL INFORMATION 23 13. CONSENT 24 14. CONTACTS BETWEEN THE PARTIES 24 15. GENERAL DISPUTE RESOLUTION 25 16. ENTIRE AGREEMENT 26 17. FORCE MAJEURE 27 18. FRAUD 27 19. HEADINGS 28 20. INTELLECTUAL PROPERTY 28 21. LAW ENFORCEMENT 29 22. LIABILITY AND INDEMNIFICATION 30 23. SUBCONTRACTORS 33 24. INSURANCE 33 25. NON-EXCLUSIVE REMEDIES 34 26. RESERVATION OF RIGHTS 34 27. NOTICES 35 28. REFERENCES 36 29. RELATIONSHIP OF THE PARTIES 36 30. SUCCESSORS AND ASSIGNS – BINDING EFFECT 37 31. SURVIVAL 37 32. TAXES/FEES 37 33. TERRITORY 38 34. THIRD-PARTY BENEFICIARIES 38 35. USE OF SERVICE 38 36. WAIVER 39 37. WITHDRAWAL OF SERVICES 39 38. TECHNOLOGY UPGRADES 39 ARTICLE III. IMPLEMENTATION 40 39. IMPLEMENTATION PLAN 40 40. SECURITY DEPOSIT 40 41. START-UP DOCUMENTATION 41 42. LETTER OF AUTHORIZATION (LOA) 41 ARTICLE IV. OPERATIONAL TERMS 44 43. STANDARD PRACTICES 44 44. ESCALATION PROCEDURES 44 45. CONTACT WITH END USERS 44 46. CAPACITY PLANNING AND FORECASTS 44 47. BONA FIDE REQUEST (BFR) 46 48. ORDERING AND PROVISIONING 48 49. BILLING AND PAYMENTS/DISPUTED AMOUNTS 49 50. AUDITS 53 51. CENTURYLINK OSS INFORMATION 54 52. NETWORK MANAGEMENT 57 53. MAINTENANCE AND REPAIR 58 ARTICLE V. INTERCONNECTION, TRANSPORT AND TERMINATION OF TRAFFIC 59 54. SERVICES COVERED 59 55. NETWORK INTERCONNECTION METHODS 59 56. SIGNALING AND INTERCONNECTION TRUNKING REQUIREMENTS 64 57. INTERCARRIER COMPENSATION 70 58. TRANSIT TRAFFIC 73 ARTICLE VI. ADDITIONAL SERVICES 76 59. NUMBER PORTABILITY 76 60. 70. ACCESS TO POLES, DUCTS, CONDUITS AND RIGHTS-OF-WAY 79 61. BASIC 911 AND E911 SERVICE 79 62. DIRECTORY ASSISTANCE 85 ARTICLE VII. PRICING 86 63. GENERAL PRICING TERMS 86 64. APPLICABILITY OF OTHER RATES, TERMS AND CONDITIONS 86 65. APPLICATION OF NON-RECURRING CHARGES 86 66. INDIVIDUAL CASE BASIS PRICING (ICB) 86 ARTICLE VIII. MISCELLANEOUS 88 67. AUTHORIZATION AND AUTHORITY 88 68. COUNTERPARTS 88 SIGNATURE PAGE 89 TABLE 1 RATES This CMRS Interconnection Agreement (“Agreement”) is entered into by and between United Telephone Company of the Northwest d/b/a CenturyLink (“CenturyLink”), and Charge Communication Inc. (“Carrier”), in its capacity as a licensed provider of Commercial Mobile Radio Service (“CMRS”). CenturyLink and Carrier are herein referred to collectively as the “Parties” and each individually as a “Party.” This Agreement covers services in the State of Oregon.
Notice of Appeal In the event that an employee who has been laid off out of seniority order believes the decision based upon performance and/or qualifications is incorrect, the employee may request that the Association appeal the Sheriff’s determination. If the Association finds there is good reason to believe that the Sheriff has erred in his decision, it may appeal through the process set forth in this Article. Such appeal shall be filed within five (5) working days of delivery of the layoff notice to the employee.
Patent Filing Responsibilities and Costs 1. The invention and patent rights herein apply to any patent application or patents covering an invention made under this Agreement. Each Party is responsible for its own costs of obtaining and maintaining patents covering sole inventions of its employees. The Parties may agree otherwise, upon the reporting of any invention (sole or joint) or in any license granted.
COMPLAINTS AND APPEALS As a Premera member, you have the right to offer your ideas, ask questions, voice complaints and request a formal appeal to reconsider decisions we have made. Our goal is to listen to your concerns and improve our service to you. If you need an interpreter to help with oral translation, please call us. Customer Service will be able to guide you through the service. WHEN YOU HAVE IDEAS We would like to hear from you. If you have an idea, suggestion, or opinion, please let us know. You can contact us at the addresses and telephone numbers found on the back cover. WHEN YOU HAVE QUESTIONS Please call us when you have questions about a benefit or coverage decision, our services, or the quality or availability of a healthcare service. We can quickly and informally correct errors, clarify benefits, or take steps to improve our service. We suggest that you call your provider of care when you have questions about the healthcare they provide.
