Expedited Appeal Process. The process by which the Appeal of an Action is accelerated because the standard time-frame for resolution of the Appeal could seriously jeopardize the Enrollee's life, health or ability to obtain, maintain or regain maximum function.
Expedited Appeal Process. 10.4.1 The Contractor shall establish and maintain an expedited appeal review process for appeals when the Contractor determines, for a request from the enrollee, or the provider indicates, in making the request on the enrollee’s behalf or supporting the enrollee’s request, that taking the time for a standard resolution could seriously jeopardize the enrollee’s life or health or ability to attain, maintain, or regain maximum function.
Expedited Appeal Process. The process by which the appeal of a Managed Care Plan’s adverse benefit determination is accelerated because the standard timeframe for resolution of the plan appeal could seriously jeopardize the enrollee’s life, health or ability to obtain, maintain or regain maximum function.
Expedited Appeal Process. CHA PACE has an expedited appeal process for situations in which you and/or your caregiver/ family believe that your life, health or ability to regain maximum function would be seriously jeopardized, absent provision of the service in dispute. In the instance of an Expedited Appeal Process: • CHA PACE will respond to the appeal in the same manner as described in the standard appeal process, as expeditiously as the participant’s health condition requires, but no later than 72 hours after it receives the appeal. • CHA PACE may extend the 72-hour time frame by up to 14 calendar days for either of the following reasons: » You request an extension » CHA PACE justifies to the MassHealth the need for additional information and how the delay is in your best interest In the event that the determination is in your favor, CHA PACE will furnish the disputed service(s) as expeditiously as the participant’s health condition requires.
Expedited Appeal Process. Action following denial of a request for expedited resolution. The following actions should be taken whenever a request for an expedited resolution of an appeal is denied: • Transfer the appeal to the standard timeframe (no longer than forty-five days (45) days) from the day the TPA/HCO receives the appeal with a possible fourteen-day (14) extension; and • Make reasonable efforts to give the enrollee prompt oral notice of the denial and written notice of the denial within two (2) calendar days.
Expedited Appeal Process. In situations in which you believe that if a service is not furnished, your life, health, or ability to regain or maintain maximum function could be jeopardized, the appeals process will be expedited if you inform us of this. A decision will be reached on an expedited appeal within 72 hours after the appeal is received. The 72 hour time frame may be extended by up to 14 calendar days if you request the extension or if PACE CNY justifies to the New York State Department of Health the need for additional information and how the delay is in your interest.
Expedited Appeal Process. Contractor’s written policies and procedures governing the resolution of appeals must include provisions for the resolution of expedited appeals as defined in the Contract. These provisions must include, at a minimum, the following requirements:
Expedited Appeal Process. 3.8.6.1 The TPA/HCO shall establish and maintain an expedited review process for appeals when the process for a standard resolution could seriously jeopardize the enrollee’s life or health, or its ability to attain, maintain, or regain maximum function.
Expedited Appeal Process. Punitive action. TPA/HCO is prohibited from undertaking any punitive action against a provider who requests an expedited resolution or supports an enrollee’s appeal.
Expedited Appeal Process. If you believe that your life, health or ability to regain or maintain maximum function could be seriously jeopardized, absent the provision of the service in dispute, let us know right away. ElderONE will answer your appeal as expeditiously as your health condition requires but within 72 hours of receipt of the appeal. This is called an expedited appeal. The 72 hour time frame may be extended by up to 14 calendar days if you request the extension or if ElderONE justifies to the New York State Department of Health the need for additional information and that this delay is in your best interest to ensure a thorough review.
