Standard Appeal Procedures Sample Clauses

Standard Appeal Procedures. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. UCD offers two (2) levels of Appeal for both administrative Appeals and Dental Necessity Appeals. If a Member is an ERISA Member, the Member is required to complete the first level of Appeal prior to instituting any civil action under ERISA section 502(a). The second level of Appeal is voluntary. Any statute of limitations or other defense based on timeliness is tolled during the time any voluntary Appeal is pending. The Member’s decision whether or not to submit to this voluntary level of review will have no effect on the Member’s rights to any other Benefits under the plan. No fees or costs will be imposed on the Member. The Member should contact his employer, Plan Administrator, Plan Sponsor, or UCD at 0-000-000-0000 if the Member is unsure whether ERISA is applicable.‌‌‌ The Member may also call UCD if they have questions or need assistance putting their Appeal in writing.
Sample 1Sample 2Sample 3See All (6)
AutoNDA by SimpleDocs
Standard Appeal Procedures. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. UCD offers two (2) levels of Appeal for both Administrative Appeals and Dental Necessity Appeals. If a Member is an ERISA Member, the Member is required to complete the first level of Appeal prior to instituting any civil action under ERISA section 502(a). The second level of Appeal is voluntary. Any statute of limitations or other defense based on timeliness is tolled during the time any voluntary Appeal is pending. The Member’s decision whether or not to submit to this voluntary level of review will have no effect on the Member’s rights to any other Benefits under the plan. No fees or costs will be imposed on the Member.‌‌ The Member should contact his employer, Plan Administrator, Plan Sponsor, or UCD at 0-000-000-0000 if the Member is unsure which process applies to him. The Member is encouraged to provide UCD with all available information to help completely evaluate the Appeal, such as written comments, documents, records, and other information relating to the Adverse Benefit Determination. UCD will provide the Member, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Adverse Benefit Determination. The Member has the right to appoint an authorized representative to represent him in his Appeals. An authorized representative is a person to whom the Member has given written consent to represent him in a review of an Adverse Benefit Determination. The authorized representative may be the Member’s treating Provider, if the Member appoints the Provider in writing. The Member may also call UCD if they have questions or needs assistance putting the Appeal in writing. All Appeals including Administrative, Dental Necessity and Expedited should be submitted in writing to: United Concordia Dental Appeals Division P.O. Box 69420 Harrisburg, PA 17106-9420 0-000-000-0000 Providers will be notified of Appeals results only if the Provider filed the Appeal.
Sample 1
Standard Appeal Procedures. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. Xxxxx Vision offers two (2) levels of Appeal for both administrative Appeals and Medical Necessity Appeals. If a Member is an ERISA Member, the Member is required to complete the first level of Appeal prior to instituting any civil action under ERISA section 502(a). The second level of Appeal is voluntary. Any statute of limitations or other defense based on timeliness is tolled during the time any voluntary Appeal is pending. The Member’s decision whether or not to submit to this voluntary level of review will have no effect on the Member’s rights to any other Benefits under the plan. No fees or costs will be imposed on the Member. The Member should contact his Employer, Plan Administrator, Plan Sponsor, or Our Customer Service Department at 0-000-000-0000 if the Member is unsure whether ERISA is applicable. The Member may also call Xxxxx Vision if they have questions or need assistance putting their Appeal in writing. Providers will be notified of Appeal results only if the Provider filed the Appeal.‌‌‌
Sample 1
Standard Appeal Procedures. UCD will determine if Your Appeal as an administrative Appeal or a Dental Necessity Appeal. Multiple requests to Appeal the same Claim, service, issue or date of service will not be considered at any level of review. You are encouraged to provide UCD with all available information to help completely evaluate Your Appeal such as written comments, documents, records, and other information relating to the Adverse Benefit Determination. Upon Your request and free of charge, we will provide You reasonable access to and copies of all documents, records, and other information relevant to Adverse Benefit Determination. You have the right to appoint an authorized representative to speak on Your behalf in Your Appeals. An authorized representative is a person to whom You have given written consent to represent You in a review of an Adverse Benefit Determination. The authorized representative may be Your treating Provider, if You appoint the Provider in writing. You may call UCD if You have questions or need assistance putting Your Appeal in writing. All Appeals including administrative Appeals, Dental Necessity Appeals and Expedited Appeals should be submitted to: United Concordia Dental Appeals Division‌‌‌ P.O. Box 69420 Harrisburg, PA 17106-9420 0-000-000-0000
Sample 1
Standard Appeal Procedures. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. If the Plan Participant has questions or needs assistance putting the Appeal in writing, the Plan Participant may call the Claims Administrator’s customer service department at 0-000-000-0000. The Plan Administrator has full discretionary authority to determine eligibility for Benefits and/or construe the terms of this Plan. The Claims Administrator will determine if the Plan Participant’s Appeal as an administrative Appeal or a dental necessity Appeal. There are two (2) levels of Appeal, the first by the Claims Administrator or its designee, and the second by the Plan Administrator, Louisiana Conference of United Methodist Church. Plan Participants are encouraged to provide the Claims Administrator with all available information to help completely evaluate the Appeal such as written comments, documents, records, and other information related to the Adverse Benefit Determination. Upon request by the Plan Participant and free of charge, the Claims Administrator will provide reasonable access to and copies of all documents records, and other information relevant to the Adverse Benefit Determination. The Plan Participant has the right to appoint an authorized representative to represent the Plan Participant in their Appeals. An authorized representative is a person to whom the Plan Participant has given written consent to represent the Plan Participant in an internal review of a denial. The authorized representative may be the Plan Participant’s treating Provider if the Plan Participant appoints the Provider in writing.
Sample 1

Related to Standard Appeal Procedures

  • Appeal Procedures A. Employees may appeal discipline imposed under this LOA through the Dispute Resolution Procedure contained in the Collective Bargaining Agreement (i.e. grievance procedure) or to the Minneapolis Civil Service Commission.

  • Appeal Procedure The Appeal will be deemed an appeal of the entire Arbitration Award. In conducting the Appeal, the Appeal Panel shall conduct a de novo review of all Claims described or otherwise set forth in the Arbitration Notice. Subject to the foregoing and all other provisions of this Paragraph 5, the Appeal Panel shall conduct the Appeal in a manner the Appeal Panel considers appropriate for a fair and expeditious disposition of the Appeal, may hold one or more hearings and permit oral argument, and may review all previous evidence and discovery, together with all briefs, pleadings and other documents filed with the Original Arbitrator (as well as any documents filed with the Appeal Panel pursuant to Paragraph 5.4(a) below). Notwithstanding the foregoing, in connection with the Appeal, the Appeal Panel shall not permit the parties to conduct any additional discovery or raise any new Claims to be arbitrated, shall not permit new witnesses or affidavits, and shall not base any of its findings or determinations on the Original Arbitrator’s findings or the Arbitration Award.

  • Referral Procedures (a) For signatory Unions now having a job referral system contained in a Schedule A, the Contractor agrees to comply with such system and it shall be used exclusively by such Contractor, except as modified by this Agreement. Such job referral system will be operated in a nondiscriminatory manner and in full compliance with federal, state, and local laws and regulations which require equal employment opportunities and non-discrimination. All of the foregoing hiring procedures, including related practices affecting apprenticeship, shall be operated so as to consider the goals of the College to encourage employment of College residents and utilization of small local businesses on the Project, and to facilitate the ability of all Contractors to meet their employment needs. The Unions will exert their best efforts to recruit and refer sufficient numbers of skilled craft workers to fulfill the labor requirements of the Contractor, including specific employment obligations to which the Contractor may be legally and/or contractually obligated; and to refer apprentices as requested to develop a larger, skilled workforce. The Unions will work with their affiliated regional and national unions, and jointly with the Community Workforce Coordinator and others designated by the College, to identify and refer competent craft persons as needed for Project Work, and to identify and hire individuals, particularly residents of the College, for entrance into joint labor/management apprenticeship programs, or to participation in other identified programs and procedures to assist individuals in qualifying and becoming eligible for such apprenticeship programs, all maintained to increase the available supply of skilled craft personnel for Project Work and future construction of maintenance work to be undertaken by the College.

  • Formal Procedures a. Upon presentation to the Vice President of a petition, signed by one-third (1/3) of the full-time members of the department who are eligible to participate, excluding the Department Chair, stating specific reasons for recalling the Department Chair, the Vice President shall promptly give fourteen (14) days written notice to all full-time department members setting forth the time, date and place of a meeting to consider the recall petition and to vote on either a motion that the Department Chair continue in office or a motion to recommend to the President that he/she declare a vacancy to exist in the chair of the department. The Department Chair may be present at this meeting.

  • Classification Appeal Procedure An employee shall have the right to appeal, through the Union, the classification of the position the employee occupies, or where a point rating plan has been used, the right to appeal the position's level. Classification matters are not grievable under Article 8 of this Agreement. Instead, the following procedures shall be followed.

  • Review Procedures The Parties agree to jointly conduct a review, sampling transactions of the incidents managed under this Agreement. Findings that are inconsistent with the normal or accepted way of doing business will be reconciled on a case by case basis. Any decision to further examine records will be considered on a case by case basis and appropriate follow up action agreed upon by all agencies involved. Payment for Protection Services (use if appropriate) Geographic, Statewide or Sub-Geographic (local) operating plans and procurement documents or agreement will establish billing procedures for Fee Basis Protection Services.

  • Informal Procedures 1. If a teacher feels that s/he may have a grievance, s/he must first discuss the matter with the person directly involved in an effort to resolve the problem informally.

  • CLAIM PROCEDURES Claim forms or claim information as to the subject policy can be obtained by contacting Benmark, Inc. (800-544-6079). When the Named Fiduciary has a claim which may be covered under the provisions described in the insurance policy, they should contact the office named above, and they will either complete a claim form and forward it to an authorized representative of the Insurer or advise the named Fiduciary what further requirements are necessary. The Insurer will evaluate and make a decision as to payment. If the claim is payable, a benefit check will be issued in accordance with the terms of this Agreement. In the event that a claim is not eligible under the policy, the Insurer will notify the Named Fiduciary of the denial pursuant to the requirements under the terms of the policy. If the Named Fiduciary is dissatisfied with the denial of the claim and wishes to contest such claim denial, they should contact the office named above and they will assist in making an inquiry to the Insurer. All objections to the Insurer's actions should be in writing and submitted to the office named above for transmittal to the Insurer.

  • Arbitration Procedures In the event that the employee and the School Board are unable to resolve any grievance, the grievance may be submitted to arbitration as defined herein:

  • General Procedures If at any time on or after the date the Company consummates a Business Combination the Company is required to effect the Registration of Registrable Securities, the Company shall use its best efforts to effect such Registration to permit the sale of such Registrable Securities in accordance with the intended plan of distribution thereof, and pursuant thereto the Company shall, as expeditiously as possible:

Time is Money Join Law Insider Premium to draft better contracts faster.