Member Appeal definition

Member Appeal means a request for a review of an action in accordance with 42 CFR 438.400, and for a person with an SMI, an appeal of an SMI eligibility determination; decisions regarding eligibility for behavioral health services, including Title XIX services, fees and waivers; assessments and further evaluations; service and treatment plans and planning decisions; and the implementation of those decisions.
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Examples of Member Appeal in a sentence

  • Appeals regarding KFHPWA denial of coverage can be submitted to the Member Appeal Department, or to KFHPWA's medical director at P.O. Box 34593, Seattle, WA 98124-1593.

  • The most current information about your appeals process is available by contacting KFHPWA’s Member Appeal Department at the address or telephone number below.

  • Appeals should be directed to KFHPWA’s Member Appeal Department, P.O. Box 34593, Seattle, WA 98124-1593, toll-free 1-866-458-5479.

  • The Enrollee can request an expedited/urgent appeal in writing to the above address, or by calling KFHPWA’s Member Appeal Department toll-free 1-866-458-5479.

  • Appeals regarding KFHPWAO denial of coverage can be submitted to the Member Appeal Department, or to KFHPWAO's medical director at P.O. Box 34593, Seattle, WA 98124-1593.

  • If the Enrollee or the Enrollee’s legal representative wishes to appeal a KFHPWA decision to deny, modify, reduce or terminate coverage of or payment for health care services, they must submit a request for an appeal either orally or in writing to KFHPWA’s Member Appeal Department, specifying why they disagree with the decision.

  • If the Member or any representative authorized in writing by the Member wishes to appeal a KFHPWA decision to deny, modify, reduce or terminate coverage of or payment for health care services, they must submit a request for an appeal either orally or in writing to KFHPWA’s Member Appeal Department, specifying why they disagree with the decision.

  • The Member can request an expedited/urgent appeal in writing to the above address, or by calling KFHPWA’s Member Appeal Department toll-free 1-866-458-5479.

  • The Member can request an expedited/urgent appeal in writing to the above address, or by calling KFHPWA’s Member Appeal Department toll-free 0-000-000-0000.

  • Appeals regarding Group Health denial of coverage can be submitted to the Member Appeal Department, or to Group Health's medical director at P.O. Box 34593, Seattle, WA 98124-1593.

Related to Member Appeal

  • Appeal Board means the State Charter School Appeal

  • Appeals Board means the commissioners and deputy commissioners of the Workers’ Compensation Appeals Board acting en banc, in panels, or individually.

  • Appeal Committee means the appeal committee established by the Council in terms of section 12(3)(a);

  • Member board means a state agency in a member state that acts in the sovereign interests of the state by protecting the public through licensure, regulation, and education of physicians as directed by the state government.

  • Board of Appeals means the local board of appeals as created by local ordinance.

  • Board of Supervisors means the Board of Supervisors of Kern County.

  • Grievance Committee means the Grievance Committee of the Bar.

  • Regional Committee means the regional committee on school

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

  • Authority Board means the board of directors of the state authority appointed under section 16.

  • Board of Review or “board” means the state building code board of review created by Iowa Code section 103A.15. The three members of the board of review are appointed by the building code commissioner from among the membership of the building code advisory council.

  • MUSL Board means the governing body of the MUSL, which is comprised of the chief executive officer of each Party Lottery.

  • Disciplinary Committee means any person or committee of persons, or any subcommittee thereof, that is author- ized by a self-regulatory organization to issue disciplinary charges, to con- duct disciplinary proceedings, to settle disciplinary charges, to impose dis- ciplinary sanctions or to hear appeals thereof.

  • Review Board has the meaning provided in Section 2.1(f)(i) of this Commercial Shared-Loss Agreement.

  • Company Board of Directors means the board of directors of the Company.

  • Decision-maker means a person who makes a determination regarding responsibility after the investigation has concluded. The Decision-maker cannot be the same person as the Title IX Coordinator, the Investigator, or the Appellate Decision-maker.

  • Division board means the board of the title guaranty division created pursuant to Iowa Code section 16.2A(1).

  • Architectural Review Committee or “ARC” shall mean the architectural review committee established by the Organization to review plans submitted to the Organization for architectural review.

  • Retirement Committee means a committee consisting of the Company’s Vice President of Human Resources, the Director of HR Operations and the Compensation & Benefits Manager.

  • Retirement board or "board" means the retirement system's governing board provided for in 2-15-1010.

  • Appeal means a request for a review of the Floodplain Administrator's interpretation of any provision of this ordinance.

  • Architectural Control Committee means and refer to that committee constituted under Article 4 hereof for the review of Development Plans (as hereinafter defined) and other functions.

  • Review Committee or “Committee” means a committee established pursuant to rule Chapter 67-60, F.A.C.

  • Executive commissioner means the executive

  • LOCAL BOARD OF TAX REVIEW and "BOARD OF TAX REVIEW" means the entity created under Section 182.18 of this Chapter.

  • ordinary member of the committee means a member of the committee who is not an officer of the Association under Rule 21;