External Reviewer definition
Examples of External Reviewer in a sentence
No punitive damages related to the denial or the reduction of benefits or payment shall be recoverable where the Member has not pursued external independent medical review where available, the External Reviewer has confirmed the HMO’s decision, or the HMO has abided by the decision of the External Reviewer.
Following initial programme approval to the satisfaction of all member institutions, drawing up an agreed scheme for programme quality assurance monitoring and review, o Monitoring and evaluation of the course including External Reviewer Reports and follow up actions, o Nomination of External Reviewers.
Reports from External Reviewers will be submitted to the AAB and will be considered in accordance with the normal procedures of the consortium The Co-ordinator will be responsible for the overall administration of the External Reviewer process and for the payment of fees and expenses to External Reviewers.
If the decision on your internal appeal is not fully in your favor, you may have your appeal reviewed by an External Reviewer through either MassHealth or Medicare’s Independent Review Entity.
At a minimum, the External Reviewer shall prepare a report (“the Report”) setting forth its detailed findings and conclusions about the quality of these loans, the levels of classified and criticized assets, and the accuracy of internally assigned loan risk grades.