Non-certification definition

Non-certification means a determination by us or our designated Utilization Review Organization that an admission, availability of care, continued stay, or other Behavioral Health Care Service has been reviewed and, based upon the information provided, does not meet our requirements for Medical or Psychological Necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service is therefore denied, reduced, or terminated. A Non-Certification is not a decision rendered solely on the basis that the Plan does not provide Benefits for the Behavioral Health Care Service in question, if the exclusion of the specific service requested is clearly stated in this Summary Plan Description.
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Non-certification means a decision not to certify an employee to permanent status in the position for which the employee is serving an initial (including extended) or subsequent probationary period.
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Non-certification means a decision not to certify a manager to permanent status in the position for which the manager is serving an initial (including extended) or subsequent probationary period.
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More Definitions of Non-certification

Non-certification means a decision not to certify a medical specialist to permanent status in the position for which the medical specialist is serving an initial (including extended) or subsequent probationary period.
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Non-certification means a determination by us (or our designated representative, if any) that an admission, availability of care, continued stay, or other health care service has been reviewed and, based upon the information provided, does not meet the our requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service is therefore denied, reduced, or terminated. A "Non-certification" is not a decision rendered solely on the basis that the Policy does not provide benefits for the health care service in question, if the exclusion of the specific service requested is clearly stated in the Certificate. Note: We ensure full investigation into any complaints filed. We agree to provide timely notification in plain English to the Member as to the progress of any investigations. We agree to provide summary data on the number and types of complaints and grievances filed on an annual basis to the Michigan Office of Financial and Insurance Regulation as required. In addition, our management is provided with a Policy Complaint Summary at regular intervals, no less than monthly, to ensure that appropriate actions have been taken in each case. These complaints and grievances are also summarized annually for management review. For any questions or concerns regarding grievance review or appeal procedures, you may contact either the Administrator (Davis Vision) or us: Davis Vision HM Life Insurance CompanyCustomer Service Customer Service159 Express Street P.O. Box 535061Plainview, NY 11803 Pittsburgh, PA 15253Toll-free: 1-800-328-4728 Toll-free: 1-800-328-5433 Claimant Cooperation Failure of a claimant to cooperate with us in the administration of the claim may result in termination of the claim. Such cooperation includes, but is not limited to, providing any information or documents needed to determine whether benefits are payable or the actual benefit amount due. Administration The Policyholder has given us the authority to review claims for the benefits provided by the Policy and for deciding appeals of denied claims. In this role we will have the authority, in our discretion, to interpret the terms of the Policy, to decide questions of eligibility for coverage or benefits under the plan, and to make any related findings of fact. All decisions made by us in this capacity will be final and binding on participants and beneficiaries of the plan to the full extent permitted by state and federal law. You are not forbidden fr...
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Related to Non-certification

  • Information Certificate means the Information Certificate of Borrower constituting Exhibit A hereto containing material information with respect to Borrower, its business and assets provided by or on behalf of Borrower to Lender in connection with the preparation of this Agreement and the other Financing Agreements and the financing arrangements provided for herein.

  • Exemption Certificate is defined in clause (e) of Section 4.6.

  • Interim Certification As defined in Section 2.02.

  • Back-Up Certification As defined in Section 3.18(k).

  • Written certification means a statement signed by a treating physician or referral physician that

  • Income Certification means a Tenant Income Certification and a Tenant Income Certification Questionnaire in the form attached as Exhibit B hereto or in such other comparable form as may be provided by the Issuer to the Owner, or as otherwise approved by the Issuer.

  • Completion Certificate means the certificate to be issued by the GIPCL when the work/ s have been completed to his satisfaction as per terms of the contract.

  • Allocation Certificate shall have the meaning set forth in Section 5.20.

  • Perfection Certificate Supplement means a certificate supplement in the form of Exhibit G-2 hereto or any other form approved by the Collateral Agent.

  • Tax Exemption Certificate means the Tax Exemption Certificate approved under the terms of this Resolution and to be executed by the Treasurer and delivered at the time of issuance and delivery of the Notes.

  • Satisfaction Certificate means the certificate materially in the form of the document contained in Call Off Schedule 5 (Testing) granted by the Customer when the Supplier has Achieved a Milestone or a Test;

  • Citizenship Certification means a properly completed certificate in such form as may be specified by the General Partner by which an Assignee or a Limited Partner certifies that he (and if he is a nominee holding for the account of another Person, that to the best of his knowledge such other Person) is an Eligible Citizen.

  • Perfection Certificates is defined in Section 5.1.

  • Occupation Certificate means any occupation certificate as referred to in s 6.4 of the Act in respect of the Development Consent;

  • certification body means a body, including product or quality systems certification bodies, that may be designated by one Party in accordance with this Part to conduct certification on compliance with the other Party's standards and/or specifications to meet relevant mandatory requirements;

  • Tax Certification Forms means any forms or other documentation as may be issued or required by a Tax Authority or by the Bank from time to time to confirm the tax status of the Customer or of a Connected Person.

  • Perfection Certificate is defined in Section 5.1.

  • Final Certification As defined in Section 2.02(a) hereof.

  • Initial Certification As defined in Section 2.02(a) hereof.

  • CEC Certification and Verification means that the CEC has certified (or, with respect to periods before the Project has commenced commercial operation (as such term is defined by and according to the CEC), that the CEC has pre-certified) that the Project is an ERR for purposes of the California Renewables Portfolio Standard and that all Energy produced by the Project qualifies as generation from an ERR for purposes of the Project.

  • Final Completion Certificate has the meaning set forth in Section 11.6.

  • Compliance certification means a submission to the department or the U.S. EPA, as appropriate, that is required under section 8 of this rule to report a NOx budget source’s or a NOx budget unit’s compliance or noncompliance with this rule and that is signed by the NOx authorized account representative in accordance with section 6 of this rule.

  • Option Certificate means the certificate, substantially in the form set out as Schedule “A” hereto, evidencing an Option;

  • NRSRO Certification A certification executed by a NRSRO in favor of the Issuer and the Information Agent that states that such NRSRO has provided the Issuer with the appropriate certifications under Exchange Act Rule 17g-5(a)(3)(iii)(B) and that such NRSRO has access to the 17g-5 Website.

  • Delay Delivery Certification As defined in Section 2.02(a) hereof.