Provider Appeals Sample Clauses

Provider Appeals. 1. The HMO must inform providers in writing (either electronically or hard copy) of the HMO’s decision to pay or deny the original claim. HMOs who use the HIPAA 835 transaction set to notify providers of payment determination must include the below elements in their contract or MOU with providers or in their provider manual, or through written notification for non-contracted providers. Written notification of payment or denial must occur on the date of action when the action is denial of payment and include the following information:
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Provider Appeals. All BadgerCare Plus and Medicaid SSI providers must appeal first to the HMO and then to the Department if they disagree with the HMO’s payment or nonpayment of a claim. The HMO must respond to the appeal within 45 days.
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Provider Appeals. Medicaid and BadgerCare providers must appeal first to the HMO and then to the Department if they disagree with the HMO’s payment or nonpayment of a claim.
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Provider Appeals. The subcontractor agrees to abide by the terms of Section O, Appeals to the MCO and Department for Payment/Denial of Providers Claims, page 136 of this article. The MCO must furnish all providers information regarding the provider appeals process at the time they enter into the contract, and through provider materials posted on the MCO’s website or sent to providers, upon request.
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Provider Appeals. 1. The PIHP must inform providers in writing (either electronically or hard copy) of the PIHP’s decision to pay or deny the original claim. PIHPs who use the HIPAA 835 transaction set to notify providers of payment determination must include the below elements in their contract or MOU with providers or in their provider manual, or through written notification for non-contracted providers. Written notification of payment or denial must occur on the date of action when the action is denial of payment and include the following information:
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Provider Appeals. 2.15.1. Contractor’s Internal Reconsideration Process for Service Providers.
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Provider Appeals. A provider may appeal regarding refusal to become a new EYE provider or withdrawal of their status as an existing EYE provider. The process for appealing is outlined below. • The provider should send (in writing) reasons for the appeal within 14 working days of a decision being notified, and include any supporting documentation. • Bath and North East Somerset will send an acknowledgement of receipt of the appeal within 5 working days. • A panel of 3 officers in the Children’s Service, who are independent of the original decision, will review the decision through a review of the supporting documentation and an interview with the provider within a further 10 working days of acknowledging the appeal. • The provider will receive a written decision on the appeal within 4 working days of the appeal decision being made. Corporate complaints procedure Should you be unhappy with the appeals process Bath and North East Somerset have a corporate complaints procedure and details can be found at this internet address: - xxxx://xxxx.xxxxxxx.xxx.xx/services/your-council-and- democracy/complaints The Local Authority Ombudsman If you are dissatisfied with your treatment under either the appeals procedure or the corporate complaints procedure, you may make a complaint to the Local Authority Ombudsman after the full appeals procedure with Bath and North East Somerset Council has been exhausted. The address for the Local Authority Ombudsman is: The Oaks, Xxxxxxxx Xxx, Xxxxxxxx Xxxxxxxx Xxxx Xxxxxxxx XX0 0XX Telephone 0000 0000000 Parent/Carer Appeals and/or Complaints A parent/carer may appeal or complain if they are unable to access their full entitlement or where they may not be receiving their EYE within the terms of the national guidance and/or Local Provider Agreement. Bath and North East Somerset’s Children’s Service procedure for can be found at the following internet address/link xxxx://xxxx.xxxxxxx.xxx.xx/services/your-council-and- democracy/complaints/complaints-about-childrens-services-0 or by calling 01225 477931
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Provider Appeals. Except for termination due Provider, and all systems, manuals, computer to contract expiration, Member Provider has the software and other materials, but excluding patient right to appeal his/her termination from the Network, charts,shall be and remain the sole property of RHG as follows: or Member Provider respectively (collectively, the "Confidential Information"), RHG and Member IX.1.3.1 RHG will provide notice to the Member Provider acknowledges that the Confidential Provider at least 90 days before the effective date of Information and all other information regarding a termination by RHG; RHG or Member Provider that is competitively sensitive is the property of RHG or Member IX.1,3.2 Upon receipt of the written notification of Provider and RHG or Member Provider may be termination, a Member Provider may request in damaged if such information was revealed to a third writing a review by the Network's advisory review i party. Accordingly, RHG and Member Provider panel no later than 30 days after receipt of the agrees to keep strictly confidential and to hold in notification; trust all Confidential Information. Upon termination of this Agreement by either party for any reason 1X.1.3.3 The Network will provide an advisory whatsoever, RHG and Member Provider shall review panel that consists of at least three Providers promptly return to the other all material constituting of the same licensure and the same or similar Confidential Information or containing Confidential specialty as the Member Provider; Information, and neither party will not thereafter use, appropriate, or reproduce such information or IX.1,3.4 The Network inust complete the advisory disclose such information to any third party. RHG panel review before the effective date of the and Member Provider specifically agrees that under termination; no circumstances will either party discuss the terms and conditions of this Agreement, and in particular 1X.1.3.5 The Client, Payor, or RHO may not notify the pricing information herein. patients of the termination until the earlier of t11e effective date of the termination or the date the IX. MISCELLANEOUS advisory review panel makes a formal recommendation; IX.1
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Provider Appeals. Amend the second sentence of the first paragraph to read: The provider has 60 calendar days from the HMO’s final appeal decision to submit all relevant information pertaining to the case(s) in question.
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Related to Provider Appeals

  • Appeals a. Should the filer be dissatisfied with the Formal Dispute determination, a written appeal may be filed with the Chief Procurement Officer, by mail or email, using the following contact information: Chief Procurement Officer Procurement Services A Division of the Office of General Services 00xx Xxxxx, Xxxxxxx Xxxxx Xxxxxx Xxxxx Xxxxx Xxxxxx, XX 00000 Email: xxxxxxxx.xxxxxxxx@xxx.xx.xxx Subject line: Appeal – Attn: Chief Procurement Officer

  • Tax Appeals Purchaser acknowledges that certain of the Sellers, as identified on the Seller Information Schedule (the “Tax Appeal Sellers”) have filed appeals (each, an “Appeal”) with respect to real estate ad valorem or other similar property taxes applicable to the Tax Appeal Properties (the “Property Taxes”).

  • System Enhancements State Street will provide to the Fund any enhancements to the System developed by State Street and made a part of the System; provided that State Street offer the Fund reasonable training on the enhancement. Charges for system enhancements shall be as provided in the Fee Schedule. State Street retains the right to charge for related systems or products that may be developed and separately made available for use other than through the System.

  • Decision-Making Authority BMS shall have the sole decision-making authority for the operations and Commercialization strategies and decisions, including funding and resourcing, related to the Commercialization of Products; provided that such decisions are not inconsistent with the express terms and conditions of this Agreement, including BMS’ diligence obligations set forth in Section 5.1.

  • Standard Hazard Insurance and Flood Insurance Policies (a) For each Mortgage Loan, the Master Servicer shall enforce any obligation of the Servicers under the related Servicing Agreements to maintain or cause to be maintained standard fire and casualty insurance and, where applicable, flood insurance, all in accordance with the provisions of the related Servicing Agreements. It is understood and agreed that such insurance shall be with insurers meeting the eligibility requirements set forth in the applicable Servicing Agreement and that no earthquake or other additional insurance is to be required of any Mortgagor or to be maintained on property acquired in respect of a defaulted loan, other than pursuant to such applicable laws and regulations as shall at any time be in force and as shall require such additional insurance.

  • Providers Services performed by a provider who has been excluded or debarred from participation in federal programs, such as Medicare and Medicaid. To determine whether a provider has been excluded from a federal program, visit the U.S. Department of Human Services Office of Inspector General website (xxxxx://xxxxxxxxxx.xxx.xxx.xxx/) or the Excluded Parties List System website maintained by the U.S. General Services Administration (xxxxx://xxx.xxx.gov/). • Services provided by facilities, dentists, physicians, surgeons, or other providers who are not legally qualified or licensed, according to relevant sections of Rhode Island Law or other governing bodies, or who have not met our credentialing requirements. • Services provided by a non-network provider, unless listed as covered in the Summary of Medical Benefits. • Services provided by naturopaths, homeopaths, or Christian Science practitioners.

  • Initiation of Appeal Following the entry of the Arbitration Award, either party (the “Appellant”) shall have a period of thirty (30) calendar days in which to notify the other party (the “Appellee”), in writing, that the Appellant elects to appeal (the “Appeal”) the Arbitration Award (such notice, an “Appeal Notice”) to a panel of arbitrators as provided in Paragraph 5.2 below. The date the Appellant delivers an Appeal Notice to the Appellee is referred to herein as the “Appeal Date”. The Appeal Notice must be delivered to the Appellee in accordance with the provisions of Paragraph 4.1 above with respect to delivery of an Arbitration Notice. In addition, together with delivery of the Appeal Notice to the Appellee, the Appellant must also pay for (and provide proof of such payment to the Appellee together with delivery of the Appeal Notice) a bond in the amount of 110% of the sum the Appellant owes to the Appellee as a result of the Arbitration Award the Appellant is appealing. In the event an Appellant delivers an Appeal Notice to the Appellee (together with proof of payment of the applicable bond) in compliance with the provisions of this Paragraph 5.1, the Appeal will occur as a matter of right and, except as specifically set forth herein, will not be further conditioned. In the event a party does not deliver an Appeal Notice (along with proof of payment of the applicable bond) to the other party within the deadline prescribed in this Paragraph 5.1, such party shall lose its right to appeal the Arbitration Award. If no party delivers an Appeal Notice (along with proof of payment of the applicable bond) to the other party within the deadline described in this Paragraph 5.1, the Arbitration Award shall be final. The parties acknowledge and agree that any Appeal shall be deemed part of the parties’ agreement to arbitrate for purposes of these Arbitration Provisions and the Arbitration Act.

  • Selection and Payment of Appeal Panel In the event an Appellant delivers an Appeal Notice to the Appellee (together with proof of payment of the applicable bond) in compliance with the provisions of Paragraph 5.1 above, the Appeal will be heard by a three (3) person arbitration panel (the “Appeal Panel”).

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

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