Appeals procedure definition

Appeals procedure means a formal process whereby a covered person, a representative of a covered person, or attending physician, facility or health care provider on a covered person’s behalf, can contest an adversehealth care treatment decision rendered by the health carrier or its designee utilization review entity (URE), which results in the denial, reduction without further opportunity for additional services or termination of coverage of a requested health care service.
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Appeals procedure means a formal process whereby a covered
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Appeals procedure means the process by which an applicant can appeal a decision of the Board in relationship to membership of the Institute.
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Examples of Appeals procedure in a sentence

  • The Appeals procedure has two (2) levels, including review by a committee at the second level on an administrative Appeal and a review by an external Independent Review Organization (IRO) on a Dental Necessity Appeal.

  • The Appeals procedure has two (2) levels, including review by a committee at the second level on an Administrative Appeal and a review by an external Independent Review Organization (IRO) on a Medical Appeal.

  • The grievance provisions and the Civil Service Appeals procedure are mutually exclusive and no relief shall be available under the Civil Service Appeals process on matters covered by this Article with the exception of matters related to discrimination and sexual harassment.

  • Further appeal shall be limited to the Board of Employee Appeals procedure contained in the Personnel Manual.

  • The Appeals procedure has two (2) levels, including review by a committee at the second level on an administrative Appeal and a review by an external Independent Review Organization (IRO) on a medical Appeal.

  • Further, it is agreed the grievance provisions and the Civil Service Appeals procedure are mutually exclusive and that no relief shall be available under the Civil Service Appeals process on matters covered by this agreement with the exception of matters related to discrimination and sexual harassment.

  • The purpose of the Appeals procedure is to assure that each Regular Member in the Orchestra, who so desires it, shall have a full and complete hearing, structured along democratic lines, before any dismissal for artistic deficiency becomes effective.

  • The following procedure is intended to be the exclusive remedy for resolving grievances, as defined below, and replaces the Grievance and Appeals procedure in the City of Los Altos’ Personnel Regulations.

  • A probationary teacher, who is dismissed, not renewed, or denied tenure, based in whole or in part upon classroom performance or any other factor measured by the APPR, shall have the right to appeal such actions through the APPR Appeals procedure.

  • In order to apply for an appeal, the student should request a copy of the Appeals procedure from Future Focus Ltd.


More Definitions of Appeals procedure

Appeals procedure. As 3(b) above SIGNED by ) for and on behalf of ) FLEXTECH plc ) /s/ Flextech plc in the presence of: ) /s/ Norma Paterson Norma Paterson SIGNED by the said ) XXXX XXXXXXAX XXXXXX ) /s/ Adam Singer in the xxxxxxxx xx: /x/ Xxephen S. Cook Stephen S. Cook SERVICE AGREEMENT BETWEEN ------------------------- FLEXTECH plc and ADAM SINGER DATED 27 MAY 1999 ---------------------------------------------- The following amendments apply to the Schedule to the Agreement: Job Title: Chairman and Chief Executive Remuneration: With effect from 1 January 2000 the fixed remuneration payable was increased to(pound)400,000 per annum.
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Appeals procedure. Any Tenant may appeal in writing to the Chair of the RGS Committee against a decision made against them by their Site Secretary or the Site Manager within three weeks, giving full reasons for the objection. This appeal will be heard by a sub-committee of appropriate committee members with no conflict of interest and the Tenant will be invited to bring their own supporter and / or witness. If the RGS committee decides against the Appeal then the Tenant may appeal to the Head of Parks at Enable Leisure and Culture. This must be done in writing, again with full details, within three weeks of the RGS Committee’s decision. Decisions made by the Head of Parks are binding.
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Appeals procedure means a formal process whereby a covered person, a representative of a covered person, attending physician, facility or health care provider can contest an adverse determination rendered by the health carrier or its designee utilization review organization, which results in the denial, reduction or termination of a requested health care service.
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Appeals procedure. The Claims Appeal procedure is described in detail on the Consortium Website. The process begins with initial contact with Excellus or Pro-Act. The appeal can be made by the patient, patient representative, or service provider. If the internal appeal process is not satisfactory, a covered person is not satisfied with an appeal determination regarding a claim that does not relate to a medical necessity or experimental/investigational services denial, the covered person may request a claim review by the GTCMHIC Appeals Committee by filing a written request for a review.
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Appeals procedure. The Claims Appeal procedure is described in detail on the Consortium Website. The process begins with initial contact with Excellus or Pro-Act. The appeal can be made by the patient, patient representative, or service provider. If the internal appeal process through the benefit plan administrator is not satisfactory, a covered person is not satisfied with an appeal determination regarding a claim that does not relate to a medical necessity or experimental/investigational services denial, the covered person may request a claim review by the GTCMHIC Appeals Committee by filing a written request for a review. Audit and Finance Committee Appointing membership to Audit and Finance Committee is the responsibility of the Board of Directors. Current membership can be found on the “Special Committee” website page. The Committee has been charged with these responsibilities:  recommend a budget  recommend premium rates  review financial reports and filings including JURAT reports  recommend reinsurance, retention, and reserving policies  audit policies and procedures to ensure compliance with Article 47 and the Certificate of Authority  review medical claims audit reports  establish a list of all reports due to the Board and regulators and the process and time line to insure accurate and timely reporting Executive Committee From the MCA: The Executive Committee of the Consortium shall consist of the Chairperson, the Vice-Chairperson, Secretary and the Chief Fiscal Officer of the Consortium. The Executive Committee may meet at any time between meetings of the Board at the discretion of the Chairperson. The Executive Committee shall make recommendations to the Board. The Executive Committee shall manage the Consortium between meetings of the Board, subject to such approval by the Board as may be required by the Agreement.
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Related to Appeals procedure

  • Appeals Panel means a panel appointed by the Chief Compliance Officer pursuant to Rule 620.

  • Complaints Procedure means the School's procedure for handling complaints from parents, as amended from time to time for legal or other substantive reasons, or in order to assist the proper administration of the School. It does not form part of the contract between you and the School. A copy of the most up-to-date procedure is on the School's website and is otherwise available from the School at any time upon request;

  • Appeals Tribunal or “AT” means the Body responsible for hearing and determining appeals set out in section 9;

  • Grievance Procedure is used in this Agreement, it shall be considered as including the arbitration procedure.

  • Appeal Panel means a panel comprised of a chair and two individuals appointed by the Board to consider appeals under Chapter 7.

  • Dispute Resolution Procedure means the procedure for resolution of Disputes set forth in Article 26;

  • Claims Procedure Order means the Order under the CCAA establishing a claims procedure in respect of the Applicant, as same may be further amended, restated or varied from time to time.

  • Appeals Board means the commissioners and deputy commissioners of the Workers’ Compensation Appeals Board acting en banc, in panels, or individually.

  • Day Case Procedure means a Medically Necessary surgical procedure for investigation or treatment to the Insured Person performed in a medical clinic, or day case procedure centre or Hospital with facilities for recovery as a Day Patient.

  • Dispute Resolution Procedures means the procedures outlined in Annexure A of the MSA Determination.

  • Claims Process means the process for Settlement Class Members’ submission of Claims, as described in Section III.

  • Settlement Procedures means the Settlement Procedures attached hereto as Exhibit A.

  • Appeals Committee means a Committee or Tribunal duly appointed by by-law to conduct hearings under this By-law;

  • Procedure means one or more surgical procedures or medical therapy performed in a Center of Excellence.

  • Claims Administration means the processing of claims made under the Shared Policies, including, without limitation, the reporting of claims to the insurance carriers and the management of the defense of claims.

  • 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.

  • Appeal Committee means the appeal committee established by the Council in terms of section 12(3)(a);

  • Variation Procedure means the procedure for carrying out a Variation as set out in Clause 16.1 (Variation Procedure);

  • Dispute Resolution means the procedure set forth in this LGIP for resolution of a dispute between the Parties.

  • Rules of Procedure means the rules of procedure adopted by the Fund Council for the management of its own business, as originally adopted on July 16, 2010 and amended from time to time.

  • Appeal Tribunal means the all-citizen Tribunal duly appointed by Council to conduct hearings under this By-law; (191-08)

  • Dispute Resolution Scheme means the Electricity and Gas Complaints Commission or such other dispute resolution scheme approved or provided for in accordance with section 95 of the Act;

  • Appeal Board means the State Charter School Appeal

  • Dispute Resolution Process means the process described in clause 9