Expedited Resolution. The Contractor shall establish and maintain an expedited review process for appeals where either the Contractor or the enrollee’s provider determines that the time expended in a standard resolution could seriously jeopardize the enrollee’s life or health or ability to attain, maintain, or regain maximum function. The Contractor shall ensure that punitive action is neither taken against a provider that requests an expedited resolution nor supports an enrollee’s appeal. In instances where the enrollee’s request for an expedited appeal is denied, the appeal must be transferred to the timeframe for standard resolution of appeals. The Contractor shall issue decisions for expedited appeals as expeditiously as the enrollee’s health condition requires, not exceeding three (3) working days from the initial receipt of the appeal. The Contractor may extend this timeframe by up to an additional fourteen (14) calendar days if the enrollee requests the extension or if the Contractor provides evidence satisfactory to the Division that a delay in rendering the decision is in the enrollee’s interest. For any extension not requested by the enrollee, the Contractor shall provide written notice to the enrollee of the reason for the delay. The Contractor shall make reasonable efforts to provide the enrollee with prompt verbal notice of any decisions that are not resolved wholly in favor of the enrollee and shall follow-up within two (2) calendar days with a written notice of action. All decisions to appeal must be in writing and shall include, but not be limited to, the following information:
Appears in 4 contracts
Samples: medicaid.ms.gov, www.medicaid.ms.gov, medicaid.ms.gov
Expedited Resolution. The Contractor shall establish and maintain an expedited review process for appeals where either the Contractor or the enrollee’s provider determines that the time expended in a standard resolution could seriously jeopardize the enrollee’s life or health or ability to attain, maintain, or regain maximum function. The Contractor shall ensure that punitive action is neither taken against a provider that requests an expedited resolution nor supports an enrollee’s appeal. In instances where the enrollee’s request for an expedited appeal is denied, the appeal must be transferred to the timeframe for standard resolution of appeals. The Contractor shall issue decisions for expedited appeals as expeditiously as the enrollee’s health condition requires, not exceeding three (3) working days from the initial receipt of the appeal. The Contractor may extend this timeframe by up to an additional fourteen (14) calendar days if the enrollee requests the extension or if the Contractor provides evidence satisfactory to the Division that a delay in rendering the decision is in the enrollee’s interest. For any extension not requested by the enrollee, the Contractor shall provide written notice to the enrollee of the reason for the delay. The Contractor shall make reasonable efforts to provide the enrollee with prompt verbal notice of any decisions that are not resolved wholly in favor of the enrollee and shall follow-up within two (2) calendar days with a written notice of action. All decisions to appeal must be in writing and shall include, but not be limited to, the following information:
Appears in 1 contract
Samples: medicaid.ms.gov
