Review Decision definition

Review Decision means the document used by the Adjudicator and the Inspector to advise Claimants and the Defendant of the determination made by the Adjudicator or the Inspector as to: (i) the correctness of the Claim Decision; (ii) whether the Claimant has acted in a manner that is fraudulent and/or abusive; (iii) to the extent the Review Decision is issued by the Inspector, whether the shingles at issue were in fact BP Organic Shingles; and (iv)
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Review Decision means a written or electronic notice in response to a request from a contracted pharmacy for a review of a failure to pay the contractual reimbursement amount of a submitted claim.
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Review Decision means a decision made under section 26(2).
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Examples of Review Decision in a sentence

  • The ERO must deliver the notice of Final External Review Decision to you, Aetna and the Plan.After a Final External Review Decision, the ERO must maintain records of all claims and notices associated with the External Review process for six years.

  • An ERO must make such records available for examination by the claimant, Plan, or State or Federal oversight agency upon request, except where such disclosure would violate State or Federal privacy laws.Upon receipt of a notice of a Final External Review Decision reversing the Adverse Benefit Determination or Final Internal Adverse Benefit Determination, the Plan immediately must provide coverage or payment (including immediately authorizing or immediately paying benefits) for the claim.

  • The opinion of the ERO's clinical reviewer or reviewers after considering the information described in this notice to the extent the information or documents are available and the clinical reviewer or reviewers consider appropriate.The assigned ERO must provide written notice of the Final External Review Decision within 45 days after the ERO receives the request for the External Review.

  • Binding Nature of the External Review Decision: If your plan is subject to federal ERISA laws (generally, any plan offered through an employer to its employees), the external review decision by the independent review organization will be final and binding on us.

  • The Notice of Final External Review Decision from the IRO is binding on the covered person, the Plan and claims processor, except to the extent that other remedies may be available under State or Federal law.

  • Post-Service / Retrospective Review: Decision within thirty (14) calendar days from receipt or request.

  • The opinion of the IRO's clinical reviewer or reviewers after considering the information described in this notice to the extent the information or documents are available and the clinical reviewer or reviewers consider appropriate.The assigned IRO must provide written notice of the Final External Review Decision within 45 days after the IRO receives the request for the External Review.

  • On the other hand, the HKIR also lodged an appeal against the Board of Review Decision in respect of the Offshore Claim.

  • Since August 2016 these fact sheets have been called the Sandy Claims Review Decision Fact Sheet.

  • Initial Internal Review Decision on Administrative GrievanceBCBSNM shall mail a written decision to you within fifteen (15) working days of receipt of the administrat- ive grievance.


More Definitions of Review Decision

Review Decision means a review decision made by the Workers' Compensation Regulator in an application for review made under section 542 of the Act.
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Review Decision means a determination under section 8A(5); and
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Related to Review Decision

  • key decision * means an executive decision which is likely to:

  • Final Decision means a final action of the commission determining the legal rights, duties, or privileges of any person. “Final decision” does not include preliminary, procedural, or intermediate actions by the commission, actions regulating the internal administration of the commission, or actions of the commission to enter into or refrain from entering into contracts or agreements with vendors to provide goods or services to the commission.

  • Land use decision means an administrative decision of a land use authority or appeal authority regarding:

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

  • Decision means a determination, action, vote, or disposition upon a motion, proposal, recommendation, resolution, order, ordinance, bill, or measure on which a vote by members of a public body is required and by which a public body effectuates or formulates public policy.

  • return decision means an administrative or judicial decision or act, stating or declaring the stay of a third-country national to be illegal and imposing or stating an obligation to return;

  • Adverse decision means a decision reducing,

  • Review Panel means the panel, if any, appointed pursuant toRule 710 to review a completed Investigation Report and to determine whether a reasonable basis exists for finding a violation of the Rules and authorizing the issuance of a notice of charge pursuant to Rule 706.

  • CPUC Decisions means CPUC Decisions 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000, 00-00-000 and any other existing or subsequent decisions, resolutions or rulings related to resource adequacy, as may be amended from time to time by the CPUC.

  • Proposed decision means the presiding officer’s recommended findings of fact, conclusions of law, decision, and order in a contested case in which the administrator did not preside.

  • Adequacy Decision means a decision issued by the European Commission that a country or region or a category of recipients in such country or region is deemed to provide an “adequate” level of data protection.

  • independent review committee means the independent review committee of the investment fund established under National Instrument 81-107 Independent Review Committee for Investment Funds;

  • the decisions means the decisions of the CMA on the questions which it is required to answer by virtue of section 35 of the Act;

  • Informed decision means a decision by a qualified patient, to request and obtain a prescription for medication that the qualified patient may self-administer to end his or her life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:

  • Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, but does not include the annual audit of the HSP’s financial statements;

  • 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.

  • Institutional Review Board or “IRB” means, in accordance with 45 C.F.R. Part 46, 21 C.F.R. part 56, and other applicable regulations, an independent body comprising medical, scientific, and nonscientific members, whose responsibility is to ensure the protection of the rights, safety, and well-being of the Human Subjects involved in a study.

  • Application Review Start Date means the later date of either the date on which the District issues its written notice that the Applicant has submitted a completed Application or the date on which the Comptroller issues its written notice that the Applicant has submitted a completed Application and as further identified in Section 2.3.A of this Agreement.

  • Expedited review means an examination, in accordance with

  • Review Package A package of documents consisting of a memorandum outlining the analysis and recommendation (in accordance with the Servicing Standard) of the Master Servicer or the Special Servicer, as the case may be, with respect to the matters that are the subject thereof, and copies of all relevant documentation.

  • Expert Determination the process described in Paragraph 6 of Schedule 8.3 (Dispute Resolution Procedure);

  • Major Decision means:

  • Reviewer means the actuary engaged to review or repeat the first actuary’s work, and

  • Final administrative decision means a decision by an agency

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

  • 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.