Common use of External Appeal Clause in Contracts

External Appeal. An Appeal, subsequent to the STAR+PLUS MMP Appeal decision, to the HHSC Fair Hearing process for Medicaid-based Adverse Benefit Determinations, or to the Medicare Independent Review Entity (IRE) process for Medicare-based Adverse Benefit Determinations. 247 1.66. External Quality Review Organization (EQRO) – An independent entity that contracts with the State and evaluates the access, timeliness, and quality of care delivered by the STAR+PLUS MMP to their Enrollees. 247

External Appeal. An Appeal, subsequent to the STAR+PLUS MMP Appeal decision, to the HHSC Fair Hearing process for Medicaid-based Adverse Benefit Determinations, or to the Medicare Independent Review Entity (IRE) process for Medicare-based Adverse Benefit Determinations. 247 1.66. External Quality Review Organization (EQRO) – An independent entity that contracts with the State and evaluates the access, timeliness, and quality of care delivered by the STAR+PLUS MMP to their Enrollees. 247.