Second Level Appeal Sample Clauses

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 0000 00xx Xxxxxx Xxxxx P.O. Box 9463 Minneapolis, MN 00000-0000 Telephone: (000) 000-0000 Outside the metro area: 0-000-000-0000 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 0000 00xx Xxxxxx Xxxxx P.O. Box 9463 Minneapolis, MN 00000-0000 Telephone: (000) 000-0000 Outside the metro area: 0-000-000-0000 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.
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Second Level Appeal. Administrative Resolution 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 level, with the CCHCS Health Care Policy and Administration Director at the following address: Second Level Appeal California Correctional Health Care Services Health Care Policy and Administration Attn: Director P. O. Box 588500, Building D Elk Grove, CA 95758 This Second Level Appeal for Administrative Resolution shall include a written certification signed by a knowledgeable company official under the penalty of perjury according to the laws of the State of California pursuant to CCP § 2015.5 that the dispute, claim, or demand is made in good faith, and that the supporting data is accurate and complete. If an Agreement adjustment is requested, the written certification shall further state under penalty of perjury that the relief requested accurately reflects the Agreement adjustment for which CCHCS is responsible. The CCHCS Health Care Policy and Administration Director shall make a determination on the issue and respond in writing within thirty (30) State business days of receipt of the Second Level Appeal, indicating the written decision. Contractor shall be notified if an extension of time is necessary.
Sample 1
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.
Sample 1
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.
Sample 1
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:
Sample 1
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Related to Second Level Appeal

  • Review and Appeal (a) Each Party shall establish or maintain judicial, quasi-judicial, or administrative tribunals or procedures for the purpose of the prompt review and, where warranted, correction of final administrative actions regarding matters covered by this Treaty. Such tribunals shall be impartial and independent of the office or authority entrusted with administrative enforcement and shall not have any substantial interest in the outcome of the matter.

  • 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. Complaints 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.

  • Offense Level Calculations i. The base offense level is 7, pursuant to Guideline § 2B1.1(a)(1).

  • 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.

  • 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:

  • 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.

  • Level 1 If an Employee wishes to submit a grievance, he/she shall first discuss the complaint with his/her immediate supervisor. The Grievance Committee representative and one administrator may also be present. This discussion must occur within ten (10) days of the event causing the complaint.

  • Level Four Arbitration

  • Level IV a. If the grievant is not satisfied with the disposition of his/her grievance at Level III, he/she may file the grievance within five (5) days of the Level III response for transmittal to the Board.

  • Level 2 If the grievant is not satisfied with the written answer from his/her manager the grievant may, within ten (10) days from the receipt of such answer, file a written appeal to the appointing authority. Within ten (10) days of the receipt of the written appeal the appointing authority shall investigate the grievance, which shall include a meeting with the concerned parties, and thereafter shall give a written answer to the grievant within ten (10) days.

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