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.

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

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

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.

Examples of Appeal decision in a sentence

It includes a situation where, in the opinion of the treating Provider, You may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision.
The administrative Appeal decision will be mailed to the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf, within thirty (30) days of receipt of the Member’s request; unless it is mutually agreed that an extension of time is warranted.
It includes a situation where, in the opinion of the treating Provider, the Member may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision.
You must make a Level II Appeal within 180 days after the date of the Level I Appeal decision.
Requests submitted to Us after four (4) months of receipt of the internal Dental Necessity Appeal decision or Rescission of Coverage will not be considered.

More Definitions of Appeal decision

Appeal decision means the decision taken by the Appeals Committee, whether to uphold or dismiss an appeal;

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.

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 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 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 decision by the IMRB regarding a review of a reconsideration decision. The "appeal decision"