Appeals Coordinator definition

Appeals Coordinator. The individual who manages a Member’s Appeal throughout the entire appeal process. Application. Health Options or the Marketplace application submitted for the purpose of securing health insurance from Health Options. Applied Behavior Analysis. The design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including the use of direct observation, measurement and functional analysis of the relations between environment and behavior. Balance Billing. When a Provider bills a Member for some or all of the remaining charges not paid by the Plan (this does not include Member Out-of-Pocket Costs). When there is an inadequate network, balance billing does not apply.
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Appeals Coordinator means the department staff responsible for receiving appeals, forwarding appeals to the hear- ing examiner, and working directly with the hearing examiner and board on administrative matters regarding an appeal.
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Appeals Coordinator means the person appointed by the Trustee as the coordinator to administer any appeal brought under these Rules. The authority and obligations of the Appeals Coordinator are provided in these rules. The duties of the Appeals Coordinator may be carried out through such other representatives as the Trustee may direct.
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Examples of Appeals Coordinator in a sentence

  • In the event of a dispute or uncertainty regarding which decision is most favorable to the Member, the PH-MCO will submit the matter to DHS’ Grievance and Appeals Coordinator for review and resolution.

  • Said appeals shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Services.

  • You or your Designee must tell your Appeals Coordinator if you wish to attend.

  • If you need to postpone the review meeting, please let your Appeals Coordinator know.

  • You may also participate in the meeting by telephone or video conferencing if you wish – please let your Appeals Coordinator know.

  • You may contact an Alliant Complaints and Appeals Coordinator at the number listed on the acknowledgement letter or notice of Adverse Benefit Determination or Final Adverse Benefit Determination.

  • In the event of a dispute or uncertainty regarding which decision is most favorable to the member, the PH-MCO will submit the matter to DPW’s Grievance and Appeals Coordinator for review and resolution.

  • Said appeals shall be sent to the attention of the ASSURIA MEDISCHE VERZEKERING N.V. Appeals Coordinator, c/o Redbridge Network & Healthcare, Inc.

  • Said appeals shall be sent to the attention of the Bupa Insurance ADMINISTRATION Company Appeals Coordinator, c/o USA Medical Services.

  • Said appeals ADMINISTRATION shall be sent to the attention of the Bupa Insurance Company Appeals Coordinator, c/o USA Medical Ser- vices.


More Definitions of Appeals Coordinator

Appeals Coordinator. The individual who manages a Member’s Appeal throughout the entire appeal process.
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Appeals Coordinator means the person responsible for coordinating the appeal. The Appeals Coordinator is a CPLED employee;
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Appeals Coordinator means the State appointed person, not involved in the initial decision-making on the case, with the responsibility for the decision on appeals.
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Appeals Coordinator means the person appointed under section 10 of this Bylaw.
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Related to Appeals Coordinator

  • Service Coordinator has the meaning set forth in Section 2.2.

  • Care Coordinator means the professional who assists members in care coordination as described in paragraph 78.53(1)“b.”

  • Program coordinator means a registered nurse responsible for administrative aspects of a state-approved nurse aide training course.

  • Scheduling Coordinator or “SC” means an entity certified by the CAISO as qualifying as a Scheduling Coordinator pursuant to the CAISO Tariff, for the purposes of undertaking the functions specified in “Responsibilities of a Scheduling Coordinator” of the CAISO Tariff, as amended from time to time.

  • Project Coordinator means the employee of Alamo Colleges District designated in Exhibit A hereto who will manage the relationship between Alamo Colleges District and Contractor. The designated employee will be knowledgeable of the Project and be experienced in managing projects similar to the one established herein.

  • Services Coordinator means an employee of the community developmental disability program or other agency that contracts with the county or Division, who is selected to plan, procure, coordinate, monitor Individual Support Plan services, and to act as a proponent for individuals with developmental disabilities.

  • Appeals Committee means a Committee or Tribunal duly appointed by by-law to conduct hearings under this By-law;

  • Title IX Coordinator means an employee of the school district that coordinates the school district’s efforts to comply with and carry out its responsibilities under Title IX. The Title IX Coordinator is responsible for acting as the primary contact for the parties and ensuring that the parties are provided with all notices, evidence, reports, and written determinations to which they are entitled under this policy and grievance process. The Title IX Coordinator is also responsible for effective implementation of any supportive measures or remedies. The Title IX Coordinator must be free from conflicts of interest and bias when administrating the grievance process.

  • Coordinator means the person designated by Canada to act as the Dispute Resolution Coordinator.

  • Service coordination means a specialized care management service that is performed by a Service Coordinator and that includes but is not limited to:

  • SBE Program Coordinator means the individual appointed, from time to time, by the City’s Community and Economic Development Director to administer the SBE Regulations.

  • Designated Representatives means the Subordination Agent Representatives, the Trustee Representatives and the Provider Representatives identified under Section 2.5.

  • Care coordination means a process-oriented activity to facilitate ongoing communication and collaboration to meet multiple needs. Care coordination includes facilitating communication between the family, natural supports, community resources, and involved providers and agencies; organizing, facilitating and participating in team meetings; and providing for continuity of care by creating linkages to and managing transitions between levels of care and transitions for young adults in transition to adult services.

  • Designated Representative has the meaning set forth in Section 6(j)(v) of this Agreement.

  • Project Managers means the person at Developer responsible for the project management of Product and identified in Schedule 2;

  • Non-Administrator Coordinated Home Care Program means a Coordinated Home Care Program which does not have an agreement with the Claim Administrator or a Blue Cross Plan but has been certified as a home health agency in accordance with the guidelines established by Medicare.

  • Project Manager means the principal employee or agent of the Recipient having administrative authority over the Project designated in Appendix B pursuant to Section VI hereof, or authorized designee as per written notification to the Director.

  • Reliability Coordinator or “RC” shall mean the entity that is the highest level of authority who is responsible for the reliable operation of the Bulk Electric System, has the wide area view of the Bulk Electric System, and has the operating tools, processes and procedures, including the authority to prevent or mitigate emergency operating situations in both next day analysis and real-time operations. The Reliability Coordinator has the purview that is broad enough to enable the calculation of Interconnection Reliability Operating Limits, which may be based on the operating parameters of transmission systems beyond any Transmission Operator’s vision.

  • Nominated Representative means, in respect of each party, the person whose details are set out in the Special Conditions (if any).

  • Order Coordination refers to standard BellSouth service order coordination involving the reuse of facilities for SL2 voice loops and all digital loops, where Choctaw is requesting that their loop order be provisioned over an existing circuit that is currently providing service to the end user. Order coordination for physical conversions will be scheduled at BellSouth’s discretion during normal working hours on the committed due date and Choctaw will be advised.

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • Independent Fiduciary means an independent fiduciary who will serve as a fiduciary to the Plan in accordance with Article 3 that has no relationship or interest in any of the Settling Parties and is mutually agreed to by the Settling Parties.

  • Review Panel means the panel, if any, appointed pursuant toRule 710 to review a completed Investigation Report and to determine whether a reasonable basis exists for finding a violation of the Rules and authorizing the issuance of a notice of charge pursuant to Rule 706.

  • Appeals Panel means a panel appointed by the Chief Compliance Officer pursuant to Rule 620.

  • Appeals Tribunal or “AT” means the Body responsible for hearing and determining appeals set out in section 9;

  • Company Representative means the person or persons appointed and approved in writing from time to time by the Company to act on its behalf for overall co- ordination.