Preliminary Determination. Upon receipt of a Grievance, we shall first determine the type of Grievance at hand. If the Grievance seeks review of an Adverse Determination of a pre- or post- Health Care Service, it is an Adverse Determination Grievance and we shall review the Grievance in accordance with our procedures for Adverse Determination Grievances and the requirements of state law. If the Grievance is not based on an Adverse Determination of a pre- or post- Health Care Service, it is an Administrative Grievance and we shall review the Grievance in accordance with its procedures for Administrative Grievances and the requirements of state laws. Timeframes for Initial Determinations Expedited decision. We shall make our initial Certification or Adverse Determination decision in accordance with the medical exigencies of the case. We shall make decisions within twenty-four (24) hours of the written or verbal receipt of the request for an expedited decision whenever: the life or health of a Grievant would be jeopardized, the Grievant’s ability to regain maximum function would be jeopardized, the Practitioner/Provider reasonably requests an expedited decision, in the opinion of the Practitioner/Provider with knowledge of the Grievant’s medical condition, would subject the Grievant to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim, the medical exigencies of the case require an expedited decision or the Grievant’s claim involves Urgent Care. Standard decision. We shall make all other initial utilization management decisions within five (5) working days. We may extend the review period for a maximum of ten (10) working days if we: can demonstrate reasonable cause beyond its control for the delay, can demonstrate that the delay will not result in increased medical risk to the Grievant, and provide a written progress report and explanation for the delay to the Grievant and Practitioner/Provider within the original five (5) working day review period. Initial Determinations
Preliminary Determination. The Laboratory shall notify the Medical Review Officer (MRO) whenever it confirms a positive, invalid, adulterated or substituted test result. The Drug Abuse Program Director will not be notified by the Laboratory of a positive, invalid, adulterated or substituted test result. During the preliminary determination of a positive, invalid, adulterated, or substituted test result the MRO will not give the Drug Abuse Program Director the Laboratory report and declarations. The MRO will give the Drug Abuse Program Director the results after positive test results are confirmed.
Preliminary Determination. The Laboratory shall notify both the Medical Review Officer and the Drug Abuse Program Director whenever it confirms a positive test result. The Scientific Services Bureau (Laboratory) shall immediately send one copy of the subjects Laboratory Report and the sealed Pre-test Declaration form to the MRO. The MRO will give a system number to the Program Director (not the test result). The Program Director will arrange an interview for the Medical Review Officer with the employee (employee's option). The Program Director will try to contact the employee utilizing the daytime telephone number designated by the employee on the pretest declaration form. The MRO is authorized to terminate the process if he/she determines that the test result was caused by appropriate use of medication. He/she will then prepare a written report to the Program Director limited to his/her statement of conclusion. No further action will be taken. If the MRO cannot close the case, he/she will contact the Program Director regarding the need for additional information in order to verify the employee's statements. The Program Director will immediately send an investigator to verify the facts presented by the employee without initiating a formal internal investigation. The information obtained by the investigator will be provided to the Medical Review Officer. The Medical Review Officer will prepare a written report to the Program Director limited to a statement of conclusion if the additional information allows him/her to determine that the test results were caused by appropriate use of prescribed medication. The Drug Abuse Program Director shall consult with the MRO on all other matters of positive test results. The decision to proceed with further administrative action is solely that of the Director. The Director in consultation with the MRO is empowered to resolve the matter upon his/her finding that a positive test has resulted from legitimate use or accidental exposure to drugs and no substantial impairment exists. If the Director determines that further administrative action is warranted, he/she shall: (1) immediately advise the appropriate executive at the level of Division Chief or higher, LASD, Bureau Chief or higher, District Attorney; and, (2) on behalf of that executive, direct Internal Affairs to conduct an administrative investigation; and (3) employee will be relieved of standard duty with pay. The employee will be provided with a copy of documentation pertaining to test re...
Preliminary Determination. The Independent Appraiser shall make a preliminary determination of the Fair Market Value of the System and System Assets (the “Preliminary Determination”).
Preliminary Determination. In connection with any Final Determination with respect to an Audit that results in an amount to be paid pursuant to Section 9.3(a), the Controlling Party shall, within 30 Business Days following a final resolution of such Audit, submit in writing to the Non-Controlling Party a preliminary determination (calculated and explained in detail reasonably sufficient to enable the Non-Controlling Party to fully understand the basis for such determination and to permit the Non-Controlling Party to satisfy its financial reporting requirements) of the portion of such amount to be paid by each of the Parties pursuant to Section 9.3(a), as applicable.
Preliminary Determination. B-14 3.2 Discipline ..........................................................................................................B-14 3.3 Refusal to Provide Urine Specimen..................................................................B-14
Preliminary Determination. The school administrators with the assistance of the teacher will make the initial determination of a policy violation.
Preliminary Determination. Upon receipt of a Grievance, we shall first determine the type of Grievance at hand. ⮚ If the Grievance seeks review of an Adverse Determination of a pre- or post- Health Care Service, it is an Adverse Determination Grievance and we shall review the Grievance in accordance with our procedures for Adverse Determination Grievances and the requirements of state law. ⮚ If the Grievance is not based on an Adverse Determination of a pre- or post- Health Care Service, it is an Administrative Grievance and we shall review the Grievance in accordance with its procedures for Administrative Grievances and the requirements of state laws.
Preliminary Determination. In connection with any Final Determination with respect to an Audit that results in an amount to be paid pursuant to Section 9.3(a), NiSource shall, within 30 Business Days following a final resolution of such Audit, submit in writing to Columbia a preliminary determination (calculated and explained in detail reasonably sufficient to enable Columbia to fully understand the basis for such determination and to permit Columbia to satisfy its financial reporting requirements) of the portion of such amount to be paid by each of the Parties pursuant to Section 9.3(a), as applicable.
Preliminary Determination. In connection with any Final Determination with respect to an Audit that results in an amount to be paid pursuant to Section 9.3(a), Fortune Brands shall, within 30 Business Days following a final resolution of such Audit, submit in writing to H&S a preliminary determination (calculated and explained in detail reasonably sufficient to enable H&S to fully understand the basis for such determination and to permit H&S to satisfy its financial reporting requirements) of the portion of such amount to be paid by each of the Parties pursuant to Section 9.3(a), as applicable.
