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.
An IRO 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.