Second Level Appeal Clause Samples

The Second Level Appeal clause establishes a formal process for escalating disputes or decisions that were not resolved satisfactorily at the initial appeal stage. Typically, this clause outlines the steps a party must take to initiate a second review, such as submitting additional documentation or appealing to a higher authority within the organization. Its core function is to provide an additional layer of review, ensuring fairness and thoroughness in the resolution of disputes or grievances.
Second Level Appeal. If you file a first level appeal and it is denied, wholly or in part, you have the right to request external review of our decision without filing a second level appeal. See below for a description of this process. If your appeal does not involve a determination of medical necessity, at your option, you or your authorized representative may, within 180 days of denial submit a written request for a second level appeal, including any relevant documents, and submit issues, comments and additional information as appropriate to: GHI Member Services Department ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ P.O. Box 9463 Minneapolis, MN ▇▇▇▇▇-▇▇▇▇ Telephone: (▇▇▇) ▇▇▇-▇▇▇▇ Outside the metro area: ▇-▇▇▇-▇▇▇-▇▇▇▇ The Member Services Department will provide the complainant with the option of either a written reconsideration, or a hearing before the Member Appeals Committee either in person or over the telephone. Hearings and written reconsiderations shall include the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons, as is deemed necessary for a fair appraisal and resolution of the appeal. During your appeal, upon your request we will provide you, free of charge, reasonable access to all documents, records and other information relevant to your appeal. We will review your appeal and written notice of the decision and all key findings will be given to the complainant within 30 calendar days of the Member Services Department’s receipt of the complainant’s written notice of appeal and request for written reconsideration. These time periods may be extended if you agree.
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Second Level Appeal. If you file a first level appeal (including pre-certification under CareCheck®) and it is denied, wholly or in part, you have the right to request external review of our decision without filing a second level appeal. See below for a description of this process. If your appeal does not involve a determination of medical necessity of Precertification, at your option, you or your authorized representative may, within 180 days of denial submit a written request for a second level appeal, including any relevant documents, and submit issues, comments and additional information as appropriate to: GHI Member Services Department ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ P.O. Box 9463 Minneapolis, MN ▇▇▇▇▇-▇▇▇▇ Telephone: (▇▇▇) ▇▇▇-▇▇▇▇ Outside the metro area: ▇-▇▇▇-▇▇▇-▇▇▇▇ The Member Services Department will provide the complainant with the option of either a written reconsideration, or a hearing before the Member Appeals Committee either in person or over the telephone. Hearings and written reconsiderations shall include the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons, as is deemed necessary for a fair appraisal and resolution of the appeal. During your appeal, upon your request we will provide you, free of charge, reasonable access to all documents, records and other information relevant to your appeal. We will review your appeal and written notice of the decision and all key findings will be given to the complainant within 30 calendar days of the Member Services Department’s receipt of the complainant’s written notice of appeal and request for written reconsideration. These time periods may be extended if you agree.
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Second Level Appeal. An employee who disagrees with the decision of the Principal may file a written appeal to the Labor/Management Panel. Appeals must be filed in writing with the Chief Human Resources Officer or designee within ten (10) working days of the receipt of the finding at the First Level Appeal. The Second Level Appeal is conducted by the Labor/Management Panel, which is composed of three Local 1 representatives appointed by Local 1, a College Business Manager appointed by the District, the Chief Human Resources Officer, and a mutually selected HR professional from another public agency. The Principal Human Resources Representative may attend and serve as a resource to the Panel. 17.5.6.2.1 On a date mutually agreed upon between the employee and the Labor/Management Panel, the Second Level Appeal meeting will convene. The Labor/Management Panel will meet with the employee and the Principal to review the findings of the First Level Appeal. The supervisor may be asked to attend and address the panel. The employee may ask that a union representative be present. 17.5.6.2.2 The Labor/Management Panel will render a decision and communicate that decision in writing to District Human Resources. The Panel’s decision must be unanimous. Human Resources will notify the employee and Local 1. Those appeals rejected due to a lack of a unanimous decision may be appealed to the Chief Human Resources Officer.
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Second Level Appeal. A second level appeal will be reviewed by the Executive Director with additional input as necessary. A second level appeal will be responded to within 60 days via a letter to Provider.
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Second Level Appeal. If the dispute or claim is still not resolved to Contractor’s satisfaction at the First Level Appeal level, Contractor may file a written Second Level Appeal, within thirty (30) calendar days following the determination from the First Level Appeal, with the HIS SSM II at the following address: California Correctional Health Care Services Healthcare Invoicing Section Attn: Appeals SSM II PO Box 588500, Building D Elk Grove, CA 95758 The Second Level Appeal shall be sent with additional supporting justification to the detailed reason(s) of dispute in regards to the First Level Appeal, along with the denial letter and all original supporting documentation provided for the First Level Appeal. The HIS SSM II or designee shall issue a written decision in response to Contractor’s Second Level Appeal within fifteen (15) calendar days of receipt of the Second Level Appeal. The written decision shall either: (a) Document the dispute settlement and what, if any, conditions were reached; or (b) Document the reason(s) the dispute could not be resolved and provide notification to Contractor of its option to file an Administrative Resolution within thirty (30) calendar days of the date of the written decision.
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Second Level Appeal. Administrative Resolution
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Second Level Appeal. If the claimant is not satisfied with the first level appeal determination, he or she has 60 days from the receipt of the first level determination to submit a written request for a second level appeal. The letter requesting the appeal must be submitted to Blue Cross and Blue Shield of Nebraska’s Second Review Unit, at the address listed on the Covered Person’s identification card. The Covered Person and/or his or her representative have the right to appear in person at the second level appeal and present the case before a review panel appointed by Blue Cross and Blue Shield of Nebraska, and/or submit additional supporting material. The majority of the panel will be health care professionals with appropriate expertise, when reviewing appeals requiring a medical judgment. The panel will not give deference to either the initial determination or the first level appeal. The panel will meet within 45 working days of receipt of the request. This panel will issue the decision within five working days after the meeting.
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Second Level Appeal. If Provider disagrees with the decision made during the first level appeal, Provider will be permitted to appeal to an appeals committee consisting of one person selected by each party to the appeal and one person mutually agreeable to both parties. The parties to the appeal will pay to the appeal committee any costs associated with the person they select and shall share the costs of the person mutually agreeable to both parties, which costs shall not be recoverable by the other party.
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Related to Second Level Appeal

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • Level I If the grievance is not resolved through informal discussions, the School District designee shall give a written decision on the grievance to the parties involved within ten (10) days after receipt of the written grievance.

  • Disciplinary Appeals All forms of disciplinary action which are not appealable to the Civil Service Commission or the courts, except written or oral reprimands and Forms 475, shall be subject to review through Steps 3, 4, 5 and 6 of the grievance procedure.