How to File an Appeal Involving a Non-Urgent Request or Claim Sample Clauses

How to File an Appeal Involving a Non-Urgent Request or Claim. In the case of an appeal involving a non-urgent request or claim, you must submit your request in writing to the following address: Appeal Coordinator — Customer Service Department Blue Cross and Blue Shield of Oklahoma P. O. Box 3283 Tulsa, Oklahoma 74102-3283 The written request should include the name of the Covered Person, the Covered Person identification number, the nature of the complaint, the facts upon which the complaint is based, and the resolution you are seeking. Necessary facts are: dates and places of services, names of Providers of services, place of hospitalization and types of services or procedures received (if applicable). You should include any documentation, including medical records that you want to become a part of the review file. The Plan Administrator may request further information if necessary.
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Related to How to File an Appeal Involving a Non-Urgent Request or Claim

  • 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.

  • Examination of an application for an industrial design 1. A formal examination of the application for an industrial design received by the federal executive authority for intellectual property is carried out which includes checks on presence of the documents specified in clause 2 of Article 1377 of the Civil Code of the Russian Federation and its compliance with the established requirements. If the result of the formal examination is positive, then a substantive examination of an application for an industrial design is carried out, which includes: information search in relation to the claimed industrial design to determine the publicly available information, which shall be taken into account when examining the design patentability; examination of the claimed industrial design for the compliance with the requirements under Article 1231.1, clause 4 of Article 1349 of the Civil Code of the Russian Federation, and the patentability criteria under the first paragraph of clause 1, clause 5 of Article 1352 of the Civil Code of the Russian Federation; examination of the claimed industrial design for the compliance with the patentability criteria under the second paragraph of clause 1 of Article 1352 of the Civil Code of the Russian Federation. An information search in relation to the objects specified in sub-clause 4 of clause 4 of Article 1349 of the Civil Code of the Russian Federation shall not be carried out, and the federal executive authority on intellectual property notifies the applicant about it. 2. If, as a result of the substantive examination of an application for an industrial design, it is found that the claimed industrial design represented on the reproductions of an external appearance of the article does not relate to the objects specified in Article 1231.1 or clause 4 of Article 1349 of the Civil Code of the Russian Federation and meets the patentability criteria under Article 1352 of the Civil Code of the Russian Federation, the federal executive authority for intellectual property makes a decision to grant a patent for an industrial design. The date of filing of the application for the industrial design and the priority date of the industrial design shall be specified in the decision. If, during the process of substantive examination of an application for an industrial design, it is found that the claimed object does not meet at least one of the requirements or patentability criteria specified in paragraph one of this clause, the federal executive authority for intellectual property makes a decision to refuse the issuance of a patent.

  • HHS Single Audit Unit will notify Grantee to complete the Single Audit Determination Form If Grantee fails to complete the form within thirty (30) calendar days after receipt of notice, Grantee maybe subject to sanctions and remedies for non-compliance.

  • Sending a Claim Notice Before beginning a lawsuit, mediation or arbitration, you and we agree to send a written notice (a claim notice) to each party against whom a claim is asserted, in order to provide an opportunity to resolve the claim informally or through mediation. Go to xxxxxxxxxxxxxxx.xxx/ claim for a sample claim notice. The claim notice must describe the claim and state the specific relief demanded. Notice to you may be provided by your billing statement or sent to your billing address. Notice to us must include your name, address and Account number and be sent to American Express ADR c/o CT Corporation System, 00 Xxxxxxx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000. If the claim proceeds to arbitration, the amount of any relief demanded in a claim notice will not be disclosed to the arbitrator until after the arbitrator rules.

  • NOTICE OF THIRD PARTY CLAIMS Pursuant to Public Contract Code Section 9201, District shall provide Contractor timely notification of the receipt of any third-party claim relating to this Contract. District shall be entitled to recover its reasonable costs incurred in providing such notification.

  • Office of Inspector General Investigative Findings Expert Review In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 531.102(m-1)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Liability Calculation Method Per Claim Unless subject to a fixed dollar copayment, the calculation of Member liability on claims for Out-of-Area Covered Health Care Services processed through the BlueCard Program will be based on the lower of the provider’s billed charges or the negotiated price made available to Blue Shield by the Host Blue. Host Blues determine a negotiated price, which is reflected in the terms of each Host Blue’s health care provider contracts. The negotiated price made available to Blue Shield by the Host Blue may be represented by one of the following:

  • Filing a Grievance Grievances may be filed by the Union on behalf of an employee or on behalf of a group of employees. If the Union does so, it will set forth the name of the employee or the names of the group of employees.

  • Indemnification for Suits or Claims for Intellectual Property Infringement The Contractor shall indemnify and hold the Owner harmless from any suits or claims of infringement of any patent rights, trademarks or copyrights arising out of any patented, trademarked, or copyrighted materials, methods, or systems used by the Contractor.

  • How to Request an External Appeal If you remain dissatisfied with our medical appeal determination, you may request an external review by an outside review agency. In accordance with §27-18.9-8, your external appeal will be reviewed by one of the external independent review organizations (IRO) approved by the Office of the Health Insurance Commissioner. The IRO is selected using a rotational method. Your claim does not have to meet a minimum dollar threshold in order for you to be able to request an external appeal. To request an external appeal, submit a written request to us within four (4) months of your receipt of the medical appeal denial letter. We will forward your request to the outside review agency within five (5) business days, unless it is an urgent appeal, and then we will send it within two (2) business days. We may charge you a filing fee up to $25.00 per external appeal, not to exceed $75.00 per plan year. We will refund you if the denial is reversed and will waive the fee if it imposes an undue hardship for you. Upon receipt of the information, the outside review agency will notify you of its determination within ten (10) calendar days, unless it is an urgent appeal, and then you will be notified within seventy-two (72) hours. The determination by the outside review agency is binding on us. Filing an external appeal is voluntary. You may choose to participate in this level of appeal or you may file suit in an appropriate court of law (see Legal Action, below). Once a member or provider receives a decision at one of the several levels of appeals noted above, (reconsideration, appeal, external), the member or provider may not ask for an appeal at the same level again, unless additional information that could affect such decisions can be provided.

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