Common use of Preliminary Review Clause in Contracts

Preliminary Review. Upon receipt of a request for an expedited external review, The Plan must immediately complete a preliminary review to determine whether the request is eligible for external review, considering the same preliminary review requirements set forth in the Preliminary Review paragraph, Standard External Review Procedures section, above. Immediately after completion of the preliminary review, The Plan will notify the Member or the Member’s authorized representative in writing as to whether the request is complete, and the request is eligible for external review. If the request is not complete, The Plan will inform the Member or the Member’s authorized representative in writing and include in the notice the information or materials that are needed to make the request complete. If the request is not eligible for external review, The Plan will inform the Member or the Member’s authorized representative in writing and include in the notice the reasons for the request's ineligibility. The notice of initial determination will include a statement informing the Member or the Member’s authorized representative of the right to appeal the determination of ineligibility to the Commissioner of Securities and Insurance. The notice will also provide contact information for the Commissioner’s office.