Internal Appeal Process Sample Clauses
The Internal Appeal Process clause establishes a formal procedure for disputing decisions or actions within an organization before seeking external remedies. Typically, it outlines the steps an individual must follow to file an appeal, such as submitting a written request, attending a hearing, or providing supporting documentation, and may set specific timelines for each stage. This clause ensures that disputes are addressed internally in a structured manner, promoting fairness and potentially resolving issues efficiently without resorting to litigation or external arbitration.
Internal Appeal Process. (i) Following confirmation of appeal validity, as noted above, the Employer (Human Resources-Job Evaluation) will conduct a further internal review based on the information provided, which may include discussions with the Employee, the Employee's Manager and/or Director and the Union. The Employer (Human Resources- Job Evaluation) will meet with the Union Representative (Classification) within sixty (60) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) following receipt of the appeal to communicate its' decision and discuss the rationale for the decision. The Employee or Management representative may attend this meeting as needed.
(ii) In the event the Union and Employee do not agree with the decision, the Union may submit an appeal to the Director, Job Evaluation (or designate), within fifteen (15) consecutive calendar days (excluding Saturday, Sundays and Named Holidays) following the date the decision was communicated in (i) above.
(iii) The Director, Job Evaluation (or designate) shall meet with the Employer (Human Resources-Job Evaluation) and Union Representative (Classification) within sixty (60) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) of the appeal being advanced to this level (Internal Appeal). Both Parties shall submit their respective positions in writing to the other Party and to the Appeal Chair no later than ten (10) consecutive calendar days (excluding Saturdays, Sundays, and Named Holidays), prior to the date of the appeal hearing.
(iv) The decision of the Director, Job Evaluation (or designate), will be communicated to the Union within ten (10) consecutive calendar days (excluding Saturdays, Sundays and Named Holidays) of the internal appeal hearing.
(v) Where a decision from this process results in an increase in pay for the affected Employees, such pay increase will be effective the date the Employee submitted the original request for review.
Internal Appeal Process. (a) When an employee wishes to have a classification decision further reviewed, the employee, in consultation with the Union should submit a written request to the Employer within thirty (30) calendar days of the date the employee became reasonably aware of the classification decision. The written request should:
(i) Confirm the desire for additional review of the classification allocation.
(ii) Outline the reason the employee believes the classification allocation is not appropriate. The reasons should specifically detail how their job duties fit within the classification specification they think is appropriate.
(iii) Include any additional information that the employee believes is necessary to evaluate the request.
(b) The Employer will conduct an internal review, which may include discussions with the employee, the Employee’s Manager and/or Director and the Union. The Employer will provide a written response to the request for appeal to the employee and the Union within ninety (90) calendar days and provide detailed rationale for the decision specifically addressing the reasons for the review provided by the employee.
(c) Should the Union in consultation with the employee not be satisfied with the internal appeal decision of the Employer, they may refer the matter to the External Appeal Process.
Internal Appeal Process a. The Plan maintains an internal appeal process involving one (1) level of review.
b. At any time during the appeal process, a Member may choose to designate an authorized representative to participate in the appeal process on his/her behalf. The Member or the Member’s authorized representative shall notify the Plan, in writing, of the designation. For purposes of the appeal process, Member includes designees, legal representatives and, in the case of a minor, parents of a Member entitled or authorized to act on the Member’s behalf. The Plan reserves the right to establish reasonable procedures for determining whether an individual has been authorized to act on behalf of a Member. Such procedures as adopted by the Plan shall, in the case of an Urgent Care Claim, permit a Professional Provider with knowledge of the Member’s medical condition to act as the Member’s authorized representative. At any time during the appeal process, a Member may contact the Member Service Department at the toll-free telephone number listed on his/her Identification Card to inquire about the filing or status of an appeal.
c. If a Member has received notification that a Claim has been denied by the Plan, in whole or in part, the Member may appeal the decision. For purposes of this Subsection, determinations made by the Plan to rescind a Member’s coverage, or to deny the enrollment request of an individual that the Plan has determined is ineligible for coverage under this Agreement, can also be appealed in accordance with the procedures set forth in this Subsection. The Member’s appeal must be submitted within one hundred eighty (180) days from the date of the Member’s receipt of notification of the adverse decision.
d. The Member, upon request to the Plan, may review all documents, records and other information relevant to the appeal and shall have the right to submit or present additional evidence or testimony which includes any written or oral statements, comments and/or remarks, documents, records, information, data or other material in support of the appeal.
e. The appeal will be reviewed by a representative from the Member Grievance and Appeals Department. The representative shall not have been involved or be the subordinate of any individual that was involved in any previous decision to deny the Claim or matter which is the subject of the Member’s appeal. In rendering a decision on the appeal, the Member Grievance and Appeals Department will take into account all evidence,...
Internal Appeal Process. (a) When an Employee wishes to have a classification decision further reviewed, the Employee, in consultation with the Union, shall submit a written request to the Classification and Compensation department, with a copy to the Employee’s Manager, within thirty (30) calendar days of the date the Employee became reasonably aware of the classification decision. The written request should:
(i) confirm their desire for an Internal Appeal of the classification decision,
(ii) outline the reason the Employee believes the classification decision is not appropriate, and
(iii) include any additional information that the Employee believes is necessary to evaluate the request.
(b) Upon receipt of the request for an internal review the Classification and Compensation department will conduct an internal review, which may include discussions with the Employee, the Employee’s Manager and/or Director and the Union. The Classification and Compensation Department shall provide a written response to the Employee and to the Union within sixty (60) calendar days of receipt of the request for an Internal Appeal and provide detailed rationale for their decision.
(c) Should the Union determine, based on the outcome of the Internal Appeal, that the classification review requires further consideration the matter may be referred to the External Appeal Process.
Internal Appeal Process. An appeal is a request to review a Notice of Action. You can request this review by phone or in writing. You must follow a request by phone in writing unless it is an expedited appeal. An adverse decision can be when Ambetter from Sunshine Health: Denies the care requested; Decreases the amount of care; Ends care that has previously been approved; Denies payment for care and you may have to pay for it.
Internal Appeal Process. The Employer (Human Resources Office) will conduct an internal review based on the information provided by the Employee and the Union. Further information that will be gathered and assessed may consist of discussions with the Employee, and Employee's Manager and the Union.
Internal Appeal Process. An appeal is a request to review a Notice of Adverse Benefit Determination (NABD). You can request this review by phone or in writing. You must follow a request by phone in writing unless it is an expedited appeal. An adverse decision can be when Ambetter from Sunshine Health: Denies the care requested Decreases the amount of care Ends care that has previously been approved Denies payment for care and you may have to pay for it
Internal Appeal Process. (a) When an Employee wishes to have a classification decision further reviewed, the Employee, in consultation with the Union, shall submit a written request to the Classification and Compensation department, within fifteen (15) days of the date the Employee became reasonably aware of the classification decision. The written request should:
(i) confirm their desire for an Internal Appeal of the classification decision,
(ii) outline the reason the Employee believes the classification decision is not appropriate. The reasons should specifically detail how their job duties fit within the classification specification the Employee thinks is appropriate, and
(iii) include any additional information that the Employee believes is necessary to evaluate the request.
(b) The Employer will conduct an internal review, which may include discussions with the Employee, the Employee’s Manager and/or Director and the Union. The Classification and Compensation Department shall provide a written response to the Employee and to the Union within sixty (60) days of receipt of the request for an Internal Appeal and provide detailed rationale for their decision, including addressing the reasons for the review request provided by the Employee.
(c) Should the Union determine, based on the outcome of the Internal Appeal, that the classification review requires further consideration the matter may be referred to the External Appeal Process.
Internal Appeal Process a. The MCO shall develop written policies and procedures for each component of its internal appeals process. The MCO's policies and procedures must include the elements specified in this contract and must be approved by the DEPARTMENT in writing. The MCO shall not be excused from meeting the requirements for the policies, procedures and pending the DEPARTMENT's written approval of these documents.
b. The MCO shall maintain a record keeping system for each level of its appeal process, which shall include a copy of the Member's request for review, the response and the resolution, which the MCO shall make available to the DEPARTMENT upon request.
c. The MCO shall clearly specify in its Member handbook/packet, the procedural steps and timeframes for each level of its internal appeals process and for filing an external appeal through the DOI. The MCO shall provide information on its internal appeals process and on the external DOI appeal process to providers and subcontractors, as it relates to Members.
d. The MCO shall develop and make available to Members and potential Members appropriate alternative language versions of internal appeal materials, including but not limited to, the standard information contained in denial notices. Such materials shall be made available in Spanish, English and any other language(s) if more than five (5) percent of the MCO's Members in the State of Connecticut served by the MCO speak the alternative language. The MCO must submit such alternative language materials to the DEPARTMENT and the DEPARTMENT must approve any such materials in writing prior to use by the MCO.
e. Internal appeals shall be filed by the applicant, the Member, the Member's authorized representative, or the Member's conservator. The Member Handbook shall state that requests for all levels of the internal appeals process shall be mailed or faxed to a single address.
Internal Appeal Process a. The MCO shall develop written policies and procedures for each component of its internal appeals process. The MCO's policies and procedures must include the elements specified in this contract and must be approved by the DEPARTMENT in writing. The MCO shall not be excused from meeting the requirements for the policies, procedures and pending the DEPARTMENT'S written approval of these documents.
b. The MCO shall maintain a record keeping system for each level of its appeal process, which shall include a copy of the Member's request for review, the response and the resolution, which the MCO shall make available to the DEPARTMENT upon request.
c. The MCO shall clearly specify in its Member handbook/packet, the procedural steps and timeframes for each level of its internal appeals process and for filing an external appeal through the DOI. The MCO shall provide information on its internal appeals process and on the external DOI appeal process to providers and subcontractors, as it relates to Members.