Only One Appeal Allowed Clause Samples

The "Only One Appeal Allowed" clause limits parties to a single opportunity to challenge a decision or judgment through the appeals process. In practice, this means that after an initial appeal is heard and resolved, no further appeals can be made regarding the same issue or case, regardless of the outcome. This clause streamlines dispute resolution by preventing prolonged litigation and repeated challenges, ensuring finality and efficiency in the legal process.
Only One Appeal Allowed. Only ONE APPEAL is allowed per initial invoice. ALL line items appealed from the initial invoice must be included on the one appeal submitted. All appeals must be submitted within sixty (60) days of payment of the initial invoice. If an appeal is submitted more than sixty (60) days following the payment of the initial invoice, the appeal will be disallowed. Upon request of the Firm, the Legal Billing Manager has sole discretion to review additional appeals or appeals submitted late. The invoice submittal date is the date the invoice was moved to “For Approval” status. This date is located under “Sent For Approval” once the invoice is moved to the “For Approval” status. Acuity vendor invoices are invoices submitted on behalf of an outside vendor, contracted by the Firm to render services on behalf of Citizens. Acuity vendor invoices are paid directly to the vendor and therefore the outside vendor’s invoice must be made payable by Citizens and not the Firm. The outside vendor can make the invoice payable to Citizens c/o the Firm. The following types of invoice must be submitted as Acuity vendor invoices, unless the expense was paid by the Firm: • Adjusters • Consultants • Experts • Investigators • Mediators • Transcript Fees • Interpreters • Video Editing • Couriers • Data Searches • Inspectors • Process • Records Requests (i.e. medical records, fire department, police department, IRS) The following expenses are NOT billable on Acuity vendor invoices and must be billed on a Firm invoice: • In Firm copy charges; • Copy charges prepared by a third party vendor in lieu of preparing the copies in Firm; and • Firm travel expenses. Vendor invoices are also uploaded using a LEDES document. An Acuity vendor invoice is uploaded under the outside vendor’s name instead of the Firm name. The outside vendor’s invoice is attached to the details tab of the invoice, instead of a line entry.

Related to Only One Appeal Allowed

  • Order of Benefit Determination Rules When a Member is covered by two or more plans, the rules for determining the order of benefit payments are as follows:

  • Appeal Panel Award The Appeal Panel shall issue its decision (the “Appeal Panel Award”) through the lead arbitrator on the Appeal Panel. Notwithstanding any other provision contained herein, the Appeal Panel Award shall (a) supersede in its entirety and make of no further force or effect the Arbitration Award (provided that any protective orders issued by the Original Arbitrator shall remain in full force and effect), (b) be final and binding upon the parties, with no further rights of appeal, (c) be the sole and exclusive remedy between the parties regarding any Claims, counterclaims, issues, or accountings presented or pleaded in the Arbitration, and (d) be promptly payable in United States dollars free of any tax, deduction or offset (with respect to monetary awards). Any costs or fees, including without limitation attorneys’ fees, incurred in connection with or incident to enforcing the Appeal Panel Award shall, to the maximum extent permitted by law, be charged against the party resisting such enforcement. The Appeal Panel Award shall include Default Interest (with respect to monetary awards) at the rate specified in the Note for Default Interest both before and after the Arbitration Award. Judgment upon the Appeal Panel Award will be entered and enforced by a state or federal court sitting in Salt Lake County, Utah.

  • Coverage for Members Who Are Hospitalized on Their Effective Date If you are in the hospital on your effective date of coverage, healthcare services related to such hospitalization are covered as long as: (a) you notify us of your hospitalization within forty-eight (48) hours of the effective date, or as soon as is reasonably possible; and (b) covered healthcare services are received in accordance with the terms, conditions, exclusions and limitations of this agreement. As always, benefits paid in such situations are subject to the Coordination of Benefits provisions.

  • Selection Under a Fixed Budget Services for assignments which the Association agrees meet the requirements of paragraph 3.5 of the Consultant Guidelines may be procured under contracts awarded on the basis of a Fixed Budget in accordance with the provisions of paragraphs 3.1 and 3.5 of the Consultant Guidelines.

  • Administrative Appeals An administrative appeal is a request for us to reconsider a full or partial denial of payment for covered healthcare services for the following reasons: • the services were excluded from coverage; • we determined that you were not eligible for coverage; • you or your provider did not follow BCBSRI’s requirements, including providing notification of service, when applicable; or • a limitation on an otherwise covered benefit exists. You are not required to file a complaint (as described above), before filing an administrative appeal. If you call our Customer Service Department, a Customer Service Representative will try to resolve your concern. If the issue is not resolved to your satisfaction, you may file a verbal or written administrative appeal with our Grievance and Appeals Unit. If you request an administrative appeal, you must do so within one hundred eighty (180) days of receiving a denial of payment for covered healthcare services. The Grievance and Appeals Unit will conduct a thorough review of your administrative appeal and respond within: • thirty (30) calendar days for a prospective review; and • sixty (60) calendar days for a retrospective review. The letter will provide you with information regarding our determination. A medical reconsideration or appeal is a request for us to reconsider a full or partial denial of payment for covered healthcare services because we determined: • the service was not medically necessary or appropriate; or • the service was experimental or investigational. You may request an expedited appeal when: • an urgent preauthorization request for healthcare services has been denied; • the circumstances are an emergency; or • you are in an inpatient setting. You or your physician may file a written or verbal request for reconsideration with our Grievance and Appeals Unit. The request for reconsideration must be submitted to us within one hundred and eighty (180) calendar days of the initial determination letter. If someone other than your provider is requesting a medical reconsideration on your behalf, you must provide us with a signed notice, authorizing the individual to represent you in this matter. You will receive written notification of our determination within fifteen (15) calendar days from the receipt of your request for reconsideration of a prospective, concurrent, or retrospective review. You may request an appeal if our denial was upheld during the initial reconsideration. Your appeal will be reviewed by a provider in the same or similar specialty as your treating provider. You must submit your request for an appeal within forty-five (45) calendar days of receiving of the reconsideration denial letter. You will receive written notification of our appeal determination following the same timeframes noted in the How to File a Medical Request for Reconsideration section above.