Internal Review Process Sample Clauses
The Internal Review Process clause establishes a formal procedure for evaluating and addressing issues, disputes, or concerns within an organization before escalating them externally. Typically, this clause outlines steps such as submitting a written complaint, designating a review committee, and setting timelines for investigation and resolution. By providing a structured mechanism for internal resolution, the clause helps organizations manage conflicts efficiently and confidentially, often preventing unnecessary external litigation or escalation.
Internal Review Process. In processing claims, BCBSNC shall be responsible for making the decision to allow or deny all initial claims for benefits that are filed by Members and for notifying each Member of the decision regarding the claim, consistent with the terms of this Agreement and Section 503 of ERISA. BCBSNC shall also be responsible for making the decision to allow or deny all appeals of denied claims for benefits and for notifying each Member of the decision regarding the appeal, consistent with the terms of this Agreement and Section 503 of ERISA. In making the decisions regarding claims for benefits and appeals of denied claims, as described in this paragraph, BCBSNC shall have discretionary authority to construe and interpret the terms of the Group Health Plan and to determine whether a claim is properly payable under the Group Health Plan.
Internal Review Process. Refers to the portion of the ADR Policy that includes the Texas Health Resources’ Employee Relations Department Review and the Internal Review Panel.
Internal Review Process. Section 10.1
Internal Review Process. The Originating Hospital shall maintain peer review and quality assurance/quality improvement activities, and retains responsibility to comply with all reporting requirements set forth in 10 N.Y.C.R.R.