Appeal decision definition

Appeal decision means a final determination made by us that arises from an appeal filed with us under our appeal process regarding a coverage decision concerning a Covered person.

Appeal decision means final determination by the Plan that arises from an Appeal.

Appeal decision means a final determination made by us that arises from an appeal filed with us under our appeal process regarding a coverage decision concerning a Covered Person.

Examples of Appeal decision in a sentence

• If we send you a notice of an Appeal decision to an address in a county where a federally mandated threshold language applies, then you or your Authorized Representative may request translation of that notice into the applicable threshold language.

• In the opinion of the treating Physician, the Member may experience pain that cannot be adequately controlled while awaiting a standard medical Appeal decision.

• In the opinion of the treating physician, the Plan Participant may experience pain that cannot be adequately controlled while awaiting a standard medical Appeal decision.

• Notice of Appeal Decision: Notice of the Appeal decision required to be sent per Section 5: Filing Claims, Appeals and Grievances shall:1.

• The Plan Manager will notify the covered person, authorized person, or provider of the Internal Appeal decision on the Adverse Determination within thirty (30) calendar days of receipt of the Internal Appeal request by the Plan Manager.

More Definitions of Appeal decision

Appeal decision means a written or electronic notice in response to an appeal under this chapter provided to a contracted pharmacy that includes a reason for the appeal denial.

Appeal decision means a final determination by Delta Dental that arises from an Appeal filed with Delta Dental under our appeal process regarding a Coverage Decision concerning an Enrollee.

Appeal decision means a written or electronic notice issued by a PBM in response to an appeal filed by a contracted pharmacy of the maximum allowable cost used to adjudicate a claim.

Appeal decision means a final determination by us after a review of an appeal regarding a coverage decision. “Compelling Reason” means a showing that the potential delay in receipt of a health care service until after

Appeal decision means a written notice provided to a contracted pharmacy that includes a reason for the appeal denial, the national drug code of the drug, and the name of a wholesale distributor from which a drug was available on the date the claim was adjudicated at a price at or below the maximum allowable cost by a pharmacy benefits manager.

Appeal decision. A final determination by the Health Plan that arises from an Appeal filed with the Health Plan under its internal Appeal process regarding a Coverage Decision concerning a Member.

Appeal decision means a final determination by a carrier that arises from an appeal filed with the carrier under its appeal process regarding a coverage decision concerning a member.