Appeals procedure definition

Appeals procedure means a formal process whereby a covered person, a representative of a covered person, or attending physician, facility or health care provider on a covered person’s behalf, can contest an adverse health care treatment decision rendered by the health carrier or its designee utilization review entity (URE), which results in the denial, reduction without further opportunity for additional services or termination of coverage of a requested health care service.

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Appeals procedure. The Claims Appeal procedure is described in detail on the Consortium Website. The process begins with initial contact with Excellus or Pro-Act. The appeal can be made by the patient, patient representative, or service provider. If the internal appeal process is not satisfactory, a covered person is not satisfied with an appeal determination regarding a claim that does not relate to a medical necessity or experimental/investigational services denial, the covered person may request a claim review by the GTCMHIC Appeals Committee by filing a written request for a review.

Appeals procedure. Any Tenant may appeal in writing to the Chair of the RGS Committee against a decision made against them by their Site Secretary or the Site Manager within three weeks, giving full reasons for the objection. This appeal will be heard by a sub-committee of appropriate committee members with no conflict of interest and the Tenant will be invited to bring their own supporter and / or witness.

Examples of Appeals procedure in a sentence

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 Dental Necessity Appeal.
Hearing appeals from institutions on behalf of students, as described in the Appeals procedure set forth in Section F below.
The grievance provisions and the Civil Service Appeals procedure are mutually exclusive and no relief shall be available under the Civil Service Appeals process on matters covered by this Article with the exception of matters related to discrimination and sexual harassment.
Further appeal shall be limited to the Board of Employee Appeals procedure contained in the Personnel Manual.
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.
If his/her appeal, under the Academic Freedom and Tenure Appeals procedure, is rejected, the redundancy will take effect.
The following procedure is intended to be the exclusive remedy for resolving grievances, as defined below, and replaces the Grievance and Appeals procedure in the City of Los Altos’ Personnel Regulations.
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.
There shall be a well-publicized Appeals procedure for both Providers and patients.
Further, it is agreed the grievance provisions and the Civil Service Appeals procedure are mutually exclusive and that no relief shall be available under the Civil Service Appeals process on matters covered by this agreement with the exception of matters related to discrimination and sexual harassment.

More Definitions of Appeals procedure

Appeals procedure means a formal process whereby a covered

Appeals procedure. As 3(b) above

Appeals procedure means the process by which an applicant can appeal a decision of the Board in relationship to membership of the Institute.

Appeals procedure means a formal process whereby a covered person, a representative of a covered person, attending physician, facility or health care provider can contest an adverse determination rendered by the health carrier or its designee utilization review organization, which results in the denial, reduction or termination of a requested health care service.