First Level Appeal Clause Samples

First Level Appeal. An employee may file a written appeal of the Principal Human Resources Representative’s finding to the First Level Appeal. Appeals must be filed in writing with the Chief Human Resources Officer within ten (10) working days of the receipt of the Principal’s recommended reclassification determination. The First Level Appeal is conducted by the Principal. 17.5.6.1.1 On a date mutually agreed upon between the Principal and the employee, the First Level Appeal will convene. The Principal will communicate with the employee to discuss the appeal. The employee’s supervisor may also be asked to address the employee’s concerns. At the employee’s request, the meeting with the Principal can be held in private. The employee may request that a union representative be in attendance. 17.5.6.1.2 The Principal will render a decision and communicate that decision in writing to the Chief Human Resources Officer. Human Resources will notify the employee and Local 1.

First Level Appeal. (a) An employee must submit a written intent to appeal to the Disability Management Provider within seven (7) calendar days of the original decision having been communicated to the employee in writing. (b) Within thirty (30) calendar days from the notice to appeal, the employee must provide the Disability Management Provider’s Case Manager with any additional medical information that the employee wishes to submit or that has been requested by the Case Manager. (c) The Disability Management Provider will provide a written decision with detailed reasons and recommendations to the employee.

First Level Appeal. A first level appeal will be reviewed by the Director of Claims. If the determination reached is unacceptable a second level appeal will be initiated.

First Level Appeal. If the claim is still not resolved to Contractor’s satisfaction at the Formal Claims Appeal level, Contractor may file, within thirty (30) calendar days after the date of the Claims Appeal response, a written First Level Appeal with the Associate Director, CCHCS, Healthcare Invoicing Branch, at the following address: Attn: First Level Appeal Associate Director Healthcare Invoicing Branch (HIB) California Correctional Health Care Services P. O. Box 588500 Elk Grove, CA 95758 The Associate Director, CCHCS, HIB or designee shall issue a written decision to Contractor within fifteen (15) calendar days from receipt of Contractor’s First Level Appeal. The written decision shall either: (1) document the dispute settlement and what, if any, conditions were reached; or (2) document the reason(s) the dispute could not be resolved and provide notification to Contractor of its option to file a Second Level Appeal within thirty (30) calendar days of the date of the written decision.

First Level Appeal. A request for a first level appeal must be submitted by the Covered Person or a representative on his or her behalf (the claimant) within six months of the date the claim was processed. The request should include the following information: a. that this is a request for an appeal; b. the reason for the appeal; c. any information that might help resolve the issue; d. the date of service/claim; and

First Level Appeal. For disagreements regarding claim payments, or claim denials by HIS for a claim billed under the Agreement, Contractor may file a First Level Appeal within thirty (30) calendar days following the determination from the Payment Inquiry, with the HIS Appeals Team at the following address: California Correctional Health Care Services Healthcare Invoicing Section Attn: Appeals Team PO Box 588500, Building D Elk Grove, CA 95758 The First Level Appeal shall be sent with a detailed reason(s) and justification of dispute, a copy of the claim originally submitted, patient’s name, CDCR number, date(s) of service, amount paid, Provider’s contact name, phone number/email address, legal authority or other basis for position, and any other documentation in support of the Appeal, and remedy sought. The Appeals Team shall review the First Level Appeal for payment or non-payment. If the review determines that CCHCS owes additional compensation, the Appeals Team shall process the reimbursement. If the review determines that CCHCS owes no additional compensation, the Appeals Team shall issue a written decision to Contractor explaining the payment denial within thirty (30) calendar days. If the review determines that Contractor was overpaid, the HIS Refunds Team will issue a refund recovery letter to Contractor within sixty (60) calendar days. CCHCS, in its sole discretion, may recover overpayments in the manner set forth in Section 63, Overpayments and Offsets of this exhibit.