Second Level Appeal Sample Clauses

Second Level Appeal. If you file a first level appeal and it is denied, wholly or in part, you have the right to request external review of our decision without filing a second level appeal. See below for a description of this process. If your appeal does not involve a determination of medical necessity, at your option, you or your authorized representative may, within 180 days of denial submit a written request for a second level appeal, including any relevant documents, and submit issues, comments and additional information as appropriate to: GHI Member Services Department 0000 00xx Xxxxxx Xxxxx P.O. Box 9463 Minneapolis, MN 00000-0000 Telephone: (000) 000-0000 Outside the metro area: 0-000-000-0000 The Member Services Department will provide the complainant with the option of either a written reconsideration, or a hearing before the Member Appeals Committee either in person or over the telephone. Hearings and written reconsiderations shall include the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons, as is deemed necessary for a fair appraisal and resolution of the appeal. During your appeal, upon your request we will provide you, free of charge, reasonable access to all documents, records and other information relevant to your appeal. We will review your appeal and written notice of the decision and all key findings will be given to the complainant within 30 calendar days of the Member Services Department’s receipt of the complainant’s written notice of appeal and request for written reconsideration. These time periods may be extended if you agree.
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Second Level Appeal. If you file a first level appeal (including pre-certification under CareCheck®) and it is denied, wholly or in part, you have the right to request external review of our decision without filing a second level appeal. See below for a description of this process. If your appeal does not involve a determination of medical necessity of Precertification, at your option, you or your authorized representative may, within 180 days of denial submit a written request for a second level appeal, including any relevant documents, and submit issues, comments and additional information as appropriate to: GHI Member Services Department 0000 00xx Xxxxxx Xxxxx P.O. Box 9463 Minneapolis, MN 00000-0000 Telephone: (000) 000-0000 Outside the metro area: 0-000-000-0000 The Member Services Department will provide the complainant with the option of either a written reconsideration, or a hearing before the Member Appeals Committee either in person or over the telephone. Hearings and written reconsiderations shall include the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons, as is deemed necessary for a fair appraisal and resolution of the appeal. During your appeal, upon your request we will provide you, free of charge, reasonable access to all documents, records and other information relevant to your appeal. We will review your appeal and written notice of the decision and all key findings will be given to the complainant within 30 calendar days of the Member Services Department’s receipt of the complainant’s written notice of appeal and request for written reconsideration. These time periods may be extended if you agree.
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Second Level Appeal. An employee who disagrees with the decision of the Principal may file a written appeal to the Labor/Management Panel. Appeals must be filed in writing with the Chief Human Resources Officer or designee within ten (10) working days of the receipt of the finding at the First Level Appeal. The Second Level Appeal is conducted by the Labor/Management Panel, which is composed of three Local 1 representatives appointed by Local 1, a College Business Manager appointed by the District, the Chief Human Resources Officer, and a mutually selected HR professional from another public agency. The Principal Human Resources Representative may attend and serve as a resource to the Panel.
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Second Level Appeal. A second level appeal will be reviewed by the Executive Director with additional input as necessary. A second level appeal will be responded to within 60 days via a letter to Provider.
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Second Level Appeal. Administrative Resolution If the dispute or claim is still not resolved to Contractor’s satisfaction at the First Level Appeal level, Contractor may file a written Second Level Appeal, within thirty (30) calendar days following the determination from the First Level Appeal level, with the CCHCS Health Care Policy and Administration Director at the following address: Second Level Appeal California Correctional Health Care Services Health Care Policy and Administration Attn: Director P. O. Box 588500, Building D Elk Grove, CA 95758 This Second Level Appeal for Administrative Resolution shall include a written certification signed by a knowledgeable company official under the penalty of perjury according to the laws of the State of California pursuant to CCP § 2015.5 that the dispute, claim, or demand is made in good faith, and that the supporting data is accurate and complete. If an Agreement adjustment is requested, the written certification shall further state under penalty of perjury that the relief requested accurately reflects the Agreement adjustment for which CCHCS is responsible. The CCHCS Health Care Policy and Administration Director shall make a determination on the issue and respond in writing within thirty (30) State business days of receipt of the Second Level Appeal, indicating the written decision. Contractor shall be notified if an extension of time is necessary.
Sample 1
Second Level Appeal. If the dispute or claim is still not resolved to Contractor’s satisfaction at the First Level Appeal level, Contractor may file a written Second Level Appeal, within thirty (30) calendar days following the determination from the First Level Appeal, with the HIS SSM II at the following address: California Correctional Health Care Services Healthcare Invoicing Section Attn: Appeals SSM II PO Box 588500, Building D Elk Grove, CA 95758 The Second Level Appeal shall be sent with additional supporting justification to the detailed reason(s) of dispute in regards to the First Level Appeal, along with the denial letter and all original supporting documentation provided for the First Level Appeal. The HIS SSM II or designee shall issue a written decision in response to Contractor’s Second Level Appeal within fifteen (15) calendar days of receipt of the Second Level Appeal. The written decision shall either:
Sample 1
Second Level Appeal. If Provider disagrees with the decision made during the first level appeal, Provider will be permitted to appeal to an appeals committee consisting of one person selected by each party to the appeal and one person mutually agreeable to both parties. The parties to the appeal will pay to the appeal committee any costs associated with the person they select and shall share the costs of the person mutually agreeable to both parties, which costs shall not be recoverable by the other party.
Sample 1
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