Minutes of a Regular Meeting, June 22-23, 2004 - Digital Collections

REGENTS’ POLICY MANUALSECTION 3—GENERAL POLICIESThe Policy Administrator will review the request and provide the Eligible Employee with a writtendetermination within 60 days. If the claim denial is reversed, the Policy Administrator will authorizepayment of the claim. If the claim is again denied, the Eligible Employee will receive a written noticecontaining:• The reason(s) why the claim, or a portion of it, was denied;• Reference to Policy provisions on which the denial was based;• What additional information, if any, is required; and• What steps may be taken if the Eligible Employee wants to proceed to a Level 2 appeal.Level 2: Director of the Office of Human Resources ReviewWithin 30 days after the Eligible Employee receives notice of a Level 1 claim denial, the EligibleEmployee may make a written request for a Level 2 Director of the Office of Human Resources Review.The Eligible Employee must submit a written request, as appropriate to:Director of the Office of Human Resources905 Asp Avenue, Room 225Norman, Oklahoma 73019The written request should state the reason why the claim should be reconsidered and include copiesof any relevant documentation, including related background information.The Director or designee will review the request within 20 days. The Eligible Employee will benotified if more information is necessary. The Eligible Employee will the receive confirmation of thedecision within 10 days of the review. The Director may affirm or reverse the decision of theAdministrative Review, or the Director may issue a “no action” letter, which is without prejudice to eitherparty. If the Eligible Employee receives a “no action” letter, he/she should proceed by requesting a Level3 review.• If the claim denial is reversed, the Director will authorize payment of the claim.• If the claim is again denied, the Eligible Employee may proceed to a Level 3 review.Level 3: Claims Appeal Committee ReviewWithin 45 days of the Level 2 decision (including a determination of “no action”) by the Director ofthe Office of Human Resources, the Eligible Employee may make a written request for a Level 3 ClaimsAppeal Committee Review. The Eligible Employee’s request should be submitted to the Office ofHuman Resources.The University’s Claims Appeal Committee consists of the Vice Presidents for Administrative Affairsor their designees.A request for a Level 3 appeal must be made within 45 days of postmark of the Level 2 decision.THE UNIVERSITY OF OKLAHOMA 208