Common use of Standard Appeal Process Clause in Contracts

Standard Appeal Process. We will determine if a Member’s Appeal is an administrative Appeal or a medical Appeal. The Appeals procedure has two (2) levels, including review by a committee at the second level on an Administrative Appeal and a review by an external Independent Review Organization (IRO) on a Medical Appeal. The Member is encouraged to provide Us with all available information to help Us completely evaluate the Appeal such as written comments, documents, records, and other information relating to the Adverse Benefit Determination. We will provide reasonable access to and copies of all documents, records, and other information relevant to the Adverse Benefit Determination.

Standard Appeal Process. We will determine if a Member’s Appeal is an administrative Appeal or a medical Appeal. The Appeals procedure has two (2) levels, including review by a committee at the second level on an Administrative administrative Appeal and a review by an external Independent Review Organization (IRO) on a Medical medical Appeal. The Member is encouraged to provide Us with all available information to help Us completely evaluate the Appeal such as written comments, documents, records, and other information relating to the Adverse Benefit Determination. We will provide reasonable access to and copies of all documents, records, and other information relevant to the Adverse Benefit Determination.