Post-Service Appeal definition

Post-Service Appeal shall have the meaning assigned to that term in § 7.11(c)(ii)(A) of this Agreement.
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Post-Service Appeal means a verbal or written request to change an Adverse Determination made by Anthem for care or service already rendered.
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Examples of Post-Service Appeal in a sentence

  • A Post-Service Appeal shall be reviewed by a committee that consists of one (1) or more PPO employees or designees who did not previously participate in the Adverse Benefit Determination and shall not be a subordinate of the person(s) who made the initial Adverse Benefit Determination.

  • A Post-Service Appeal, whether denied in whole or in part based on a medical judgment, will be reviewed and a decision made no later than sixty (60) days after receipt of the written request.

  • The Physician shall have the option to submit a written request for External Review within sixty (60) days from the date of the internal Post-Service Appeal denial decision by Company.

  • A Post-Service Appeal is a request to change an Adverse Benefit Determination for care or services that have already been received by the Member.

  • A Post-Service Appeal of any Adverse Benefit Determination that is based in whole or in part on a medical judgment, will be reviewed by a PPO Medical Director who did not previously participate in any prior decision relating to the appeal and shall not be a subordinate of the person(s) who made the initial Adverse Benefit Determination.

  • The committee will consider the full record of the Post-Service Appeal and make a determination independent of previous reviewers.