Request for Expedited External Review Sample Clauses

The Request for Expedited External Review clause allows a party to seek a faster-than-normal review of a decision or claim by an independent third party, typically in situations where a delay could seriously jeopardize the individual's health or well-being. This clause outlines the criteria under which an expedited review can be requested, such as urgent medical needs, and describes the process for submitting such a request, including any required documentation or timeframes. Its core function is to ensure that critical issues are addressed promptly, providing a mechanism for swift resolution when standard review timelines would be inadequate.
Request for Expedited External Review. Under the following circumstances, the Member may request an expedited external review: a. If the Member received an adverse benefit determination that denied the Member’s claim and: 1. the Member filed a request for an internal Urgent Care appeal; and 2. the delay in completing the internal appeal process would seriously jeopardize the life or health of the Member or the Member’s ability to regain maximum function; or b. Upon receipt of a final internal adverse benefit determination which involves: 1. a medical condition of the Member for which a delay in completing the standard external review would seriously jeopardize the Member’s life or health or the Member’s ability to regain maximum function; or 2. an admission, availability of care, a continued stay, or a health care item or service for which the Member received Emergency Services, but has not been discharged from a facility.
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Related to Request for Expedited External Review

  • Credit for Experience 33.01 Credit for nursing experience will be credited on the following basis: (a) The Employer will credit a newly hired regular full-time nurse with one (1) annual service increment for each completed year of related experience up to the after eight (8) years step of the salary grid and credit a regular part-time nurse, up to the after twelve thousand (12,000) hours step, based on substantiated hours worked. (b) If there has been a break in excess of two years in the nurses’ full-time or part-time employment, then the number of increments to be provided shall be at the discretion of the Employer. 33.02 In order to receive credit for experience it is the nurse’s responsibility to provide the Employer with verification satisfactory to the Employer, of previous related experience during her probationary period. Should a nurse fail to provide such satisfactory verification during her probation she shall forfeit the provisions of this Article. 33.03 Once established consistent with the above provisions, credit for recent related experience will be retroactive to the new nurses date of hire. 33.04 Nurses on staff prior to the signing of this agreement, will be credited with experience as set out under this Article, effective the first full pay period following the date the Employer has confirmed entitlement to such increment, subject to 33.02 above.

  • External Review In the event of a final internal Adverse Benefit Determination, a Claimant may be entitled to an external review of the Claim. This request must be submitted in writing on an External Review Request form within 120 days of receipt of the Adverse Benefit Determination. The external reviewer will render a recommendation within 45 calendar days unless the request meets expedited criteria, in which case it will be resolved in no later than 72 hours. The external reviewer’s recommendation will be binding. The external reviewer will notify the Claimant of its decision in writing, and the Plan will take action as appropriate to comply with such recommendation. For detailed information about the external review process, please contact ▇▇▇▇▇’s Member Engagement Center.

  • Annual Review The Board of Directors during the Contract Period shall review annually, or at more frequent intervals which the Board of Directors determines is appropriate, the Executive’s compensation and shall award the Executive additional compensation to reflect the Executive’s performance, the performance of the Company and competitive compensation levels, all as determined in the discretion of the Board of Directors.