Provider Appeal Resolution Process Sample Clauses

Provider Appeal Resolution Process. (a) Blue Shield’s Provider Appeal resolution process (“Appeal Process”) shall comply with Sections 1367(h), 1371, 1371.1, 1371.2, 1371.22, 1371.35, 1371.36, 1371.37, 1371.4, and 1371.8 of the Health & Safety Code and Sections 1300.71, 1300.71.38, 1300.71.4, and 1300.77.4 of Title 28 of the Cal. Code of Regulations. It shall be described in the Provider Manual and on the provider portal of Blue Shield’s website at xxx.xxxxxxxxxxxx.xxx.
AutoNDA by SimpleDocs

Related to Provider Appeal Resolution Process

  • Informal Resolution Process It is the declared objective of the University and the Union to encourage the prompt resolution of potential causes for dismissal in the interest of maintaining harmony within the campus environment. Whenever practicable, before a formal recommendation for dismissal is initiated, every effort should be made to resolve or remediate the problem. Unless the individual concerned requests otherwise, the following efforts to resolve the problem will be undertaken in all cases where the issue is the individual’s performance and may be undertaken at the University’s discretion in other instances. The Department Personnel Committee, the Department Chair or Head, the individual concerned, and his or her union representatives may review the matter and explore a mutually acceptable resolution of the matter. The Xxxxxxx and/or appropriate Xxxx may, upon request of the Department Personnel Committee, the Department Chair or Head, the individual concerned, or the union representatives, join in the discussions about resolving the matter. Informal attempts at resolution shall not extend beyond thirty days without the written agreement of the individual concerned and the Xxxxxxx.

  • Issue Resolution Process Section 1001:

  • Issue Resolution Procedures As soon as possible after any occupational health and safety issue has been reported, the company’s or management representative and elected safety representative must meet to try to resolve the issue. The resolution of the issue must take into account those of the following factors that are relevant: o Whether the hazard or risk can be isolated o The number and location of employees affected o Whether appropriate temporary measures are possible or desirable o Whether environmental monitoring is desirable o The time that may elapse before the hazard or risk is permanently corrected o Who is responsible for performing work and overseeing the removal of the hazard or risk. As soon as possible after the resolution of an issue, details of the agreement must be brought to the attention of affected employees in an appropriate manner. Should the matter not be resolved, the issue shall be dealt with in line with Clause 20 of the VBIA “Safety Disputes Resolution Procedure”.

  • Complaint Resolution We operate a complaints procedure to enable resolution to complaints; these must be advised in Writing directly to us, to enable our formal complaints process to be applied.

  • Resolution Procedure a. Step 1

  • Informal Resolution Outcomes a. When a complainant approaches an administrative officer and alleges harassment by another BCTF member, the following shall apply:

  • Problem Resolution The parties will endeavour to resolve any problems identified with the operation of this Agreement as they arise.

  • Grievance Commissioner System This is to confirm the discussion of the parties during collective bargaining that they are committed to encouraging early discussion and resolution of labour relations issues at the local level and seek to resolve grievances in a timely and cost efficient manner. To that end, this is to confirm that pursuant to Article 8, the parties agree that the Employer and Union at individual nursing homes may agree to utilize the following process in order to resolve a particular grievance through the utilization of a joint mediation-arbitration procedure:

  • 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.

  • Grievance Resolution If a grievance is resolved at Step 2 or 3 in the procedure as provided herein, the grievant concerned shall indicate acceptance of the resolution by affixing his/her signature in the appropriate space indicated. If the employee has been represented by the Union at the Step of the procedure at which a resolution is reached, the Union representative shall also sign the appropriate document acknowledging that the employee has accepted the resolution. Decisions on grievances where an employee represents him/herself shall not be considered precedent setting or binding with regard to any future grievances filed with respect to the same or similar matters.

Time is Money Join Law Insider Premium to draft better contracts faster.