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. 13.4.1 The Contractor must establish and maintain an expedited appeal review process for appeals when the Contractor determines or a provider indicates that taking the time for a standard resolution could seriously jeopardize the Enrollee’s life, physical or mental health or ability to attain, maintain, or regain maximum function (42 C.F.R. § 438.410(a)).
Expedited Appeal Process. Action following denial of a request for expedited resolution. Anytime that CONTRACTOR denies a request for an expedited resolution of an appeal, it shall do the following: • Transfer the appeal to the standard timeframe of no longer than forty-five days (45) days from the day the CONTRACTOR 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 a written notice within two (2) calendar days.
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. 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. 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 and we will process your appeal through as an expedited appeal. ElderONE will respond to your appeal as quickly as your health condition requires, but no later 72 hours of receipt of the 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. If XxxxxXXX decides in your favor, we must provide the disputed service as quickly as your health condition requires. If the decision is not fully in your favor, we will provide you with written notice of the denial. The notice will include the specific reason(s) for the denial, the reason(s) why the service would not improve or maintain your overall health, information about your right to appeal the decision, and a description of your external appeal rights.
Expedited Appeal Process. The Contractor shall establish and maintain an Expedited Appeal Process for Appeals when the Contractor determines or a BHA indicates that taking the time for a standard resolution of an Appeal could seriously jeopardize the Enrollee’s life or health and ability to attain, maintain, or regain maximum function (42 CFR § 438.410(a)).
Expedited Appeal Process. 1. MCO must establish and maintain an expedited review process for appeals for situations in which MCO determines, based on a request from the Enrollee or from a provider on behalf of the Enrollee, 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. An expedited appeal process is available for situations in which 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 dis- pute. • 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 up to 14 cal- endar days if you request the extension or if ESC justifies to the New York State Department of Health the need for additional information and how the delay is in your interest. External Appeal Options • Medicaid participants have the right to request a State Fair Hearing if they are unsatisfied with the outcome of the ESC appeal process. ESC staff will help you in accessing your State Fair Hearing rights. These appeals are con- ducted by the New York State Office of Hearing and Appeals • If you are a Medicare recipient and you are unsatisfied with the outcome of the ESC appeal process you may choose to appeal to Medicare. ESC staff will help you in accessing the Medicare appeal process. The appeal will be sent to The Centers for Medicare and Medicaid Services’ (CMS) Independ- ent Review Entity (IRE). • If you have both Medicaid and Medicare, ESC staff will assist you in choos- ing which agency to appeal to and accessing the chosen agency. Both agen- cies cannot review the appeal. Voicing your concerns to the New York State Department of Health. You can contact the New York State Department of Health at any time to voice a complaint. You may voice your concern regarding Eddy SeniorCare by calling the NYS Department of Health Managed Care Complaint Line at 0-000-000-0000. You can also call the NYS HomeCare Hot Line at: 0-000-000-0000 to voice concerns about the homecare services you are receive through Eddy SeniorCare.
