Medicare Appeals Council Sample Clauses

Medicare Appeals Council.  If the ALJ decides against you, you must request a review by the Medicare Appeals Council within 60 days of receiving the ALJ’s decision.  For beneficiary-initiated appeals, the Appeals Council should make a decision within 90 days of receiving the request for a hearing. Federal District Court  If the Appeals Council decides against you, follow the directions in the denial to file for judicial review in federal district court.  You must file within 60 days of receiving the Appeals Council’s decision.  You must meet the amount in controversy requirement. The amount in controversy is adjusted annually.
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Medicare Appeals Council. If a Participant disagrees with the Integrated Administrative Hearing Officer’s decision, the Participant may appeal that decision further to the Medicare Appeals Council, which may overturn the Integrated Administrative Hearing Officer’s decision. An adverse Administrative Hearing decision may be appealed to the Medicare Appeals Council within 60 calendar days. This serves as the third level of appeal. These appeals must be filed with the FIDA-IDD Administrative Hearing Unit, which will forward the request for appeal and administrative record to the Medicare Appeals Council in the manner specified in the Three-way Contract. The Medicare Appeals Council will complete a paper review and will issue a decision within 90 calendar days. Benefits will continue pending an appeal in accordance with section IX.a.ii.12. CMS and NYSDOH/OPWDD will provide the Administrative Appeals Judges with FIDA-IDD Demonstration specific information.
Sample 1
Medicare Appeals Council. 3.7.1. If a member disagrees with the OAH decision, the member may appeal that decision further to the Medicare Appeals Council (MAC), which may overturn the decision. This serves as the third level of appeal. Xxxxx appealed to the MAC will be reviewed on the basis of the record compiled by OAH, and, upon request by the MAC, any supplemental record or argument submitted by the parties to the appeal. The Medicare Appeals Council will apply all Medicare and Medicaid coverage rules as specified in the MAP plan’s Member Handbook and the model contract between the participating plan and DOH, as well as the Evidence of Coverage of the exclusively aligned MAP-participating D-SNP.
Sample 1
Medicare Appeals Council. If a Participant disagrees with the Integrated Administrative Hearing Officer’s decision, the Participant may appeal that decision further to the Medicare Appeals Council, which may overturn the Integrated Administrative Hearing Office’s decision. The Medicare Appeals Council will apply all Medicare and Medicaid coverage rules as specified in Appendix A of this contract. The Participant submits his/her request for Medicare Appeals Council review to the Integrated Administrative Hearing Office. This must be done within sixty (60) calendar days of the date of the adverse decision by the Integrated Administrative Hearing Office. The Integrated Administrative Hearing Office will forward the Appeal and the record to the Medicare Appeals Council. These Appeals must be filed with the FIDA Administrative Hearing Unit, which will forward the request for Appeal and administrative record to the Medicare Appeals Council. The Medicare Appeals Council will complete a paper review and will issue a decision within ninety (90) calendar days from the receipt of the appeal request. Benefits will continue pending an Appeal in accordance with Section 2.13.1.2.2.12.
Sample 1
Medicare Appeals Council. 3.7.1. The member may appeal adverse IAHO decisions to the Medicare Appeals Council. Xxxxx appealed to the MAC will be reviewed on the basis of the record compiled by the IAHO, and, upon request by the MAC, any supplemental record or argument submitted by the parties to the appeal. The Medicare Appeals Council will apply all Medicare and Medicaid coverage rules as specified in the MAP plan’s Member Handbook and the model contract between the participating plan and DOH, as well as the Evidence of Coverage of the exclusively aligned MAP-participating D-SNP.
Sample 1

Related to Medicare Appeals Council

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Medical Care Leave An Employee who is unable to make the necessary arrangements for maintenance of personal health care outside of scheduled work time, shall be granted time off with pay. Such time off shall not exceed sixteen (16) working hours per calendar year. Hours in excess of sixteen (16) hours per calendar year shall be deducted from the Employee's sick leave accumulation.

  • Administrative Appeals An administrative appeal is a request for us to reconsider a full or partial denial of payment for covered healthcare services for the following reasons: • the services were excluded from coverage; • we determined that you were not eligible for coverage; • you or your provider did not follow BCBSRI’s requirements; or • a limitation on an otherwise covered benefit exists. You are not required to file a complaint (as described above), before filing an administrative appeal. If you call our Customer Service Department, a Customer Service Representative will try to resolve your concern. If the issue is not resolved to your satisfaction, you may file a verbal or written administrative appeal with our Grievance and Appeals Unit. If you request an administrative appeal, you must do so within one hundred eighty (180) days of receiving a denial of payment for covered healthcare services. The Grievance and Appeals Unit will conduct a thorough review of your administrative appeal and respond within: • thirty (30) calendar days for a prospective review; and • sixty (60) calendar days for a retrospective review. The letter will provide you with information regarding our determination.

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Dental Care Plan The Welfare Plan will include a Dental Care Plan which will reimburse members for expenses incurred in respect of the coverages summarized in Appendix "1". The Plan will not duplicate benefits provided now or which may be provided in the future by any government program.

  • Health Care Benefits (a) Each regular full-time employee may elect coverage for himself and his eligible dependents* under one of the following health insurance plans:

  • 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:

  • Health Care Matters Without limiting the generality of any representation or warranty made in Article 7 or any covenant made in Articles 8 or 9, each Borrower represents and warrants on a joint and several basis to and covenants with the Administrative Agent and each Lender, and shall be deemed to represent, warrant and covenant on each day on which any advance or accommodation in respect of any Loan is requested or made or any Liabilities shall be outstanding under this Agreement (or any Affiliate Term Loan Liabilities shall be outstanding under the Term Loan Agreement), that:

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

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