Appeal time frames Sample Clauses
Appeal time frames. Enrollees, their authorized representatives, and providers for Medicare service appeals will have 90 days to file an appeal related to denial, reduction, or termination of authorized Medicare benefit coverage. Enrollees, their providers, or their authorized representatives will have 90 days to file an MCO/SNP appeal related to the denial of services or payment or the reduction or termination of previously authorized Medicaid or Medicare/Medicaid hybrid benefit coverage. The 90-day period extends the typical Medicare period by 30 days to allow for additional flexibility for Beneficiaries and to align the Medicaid and Medicare timelines.
Appeal time frames. Enrollees, their authorized representatives, and providers for Medicare service appeals will have 90 days to file an appeal related to denial, reduction, or termination of authorized Medicare benefit coverage. Enrollees, their providers, or their authorized representatives will have 90 days to file an MCO/SNP appeal related to the denial of services or payment or the reduction or termination of previously authorized Medicaid or Medicare/Medicaid hybrid benefit coverage. The 90-day period extends the typical Medicare period by 30 days to allow for additional flexibility for Beneficiaries and to align the Medicaid and Medicare timelines. Unless otherwise described above or in Appendix 5, all relevant Medicare Advantage and Medicaid managed care requirements will remain in place. Part D appeals and grievances will continue to be managed under existing Part D rules, and non-Part D pharmacy appeals will be managed under the current State process including state fair hearings. CMS and the State will work to continue to coordinate grievances and appeals for pharmacy benefits.