Expedited Dental Necessity Appeal Sample Clauses

Expedited Dental Necessity Appeal. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize the Member’s life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, the Member may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal is a request concerning an Admission, availability of care, continued stay, or dental healthcare service for a covered person who is requesting Emergency services or has received Emergency services, but has not been discharged from a facility. Expedited Appeals are not provided for review of services previously rendered. An Expedited Appeal shall be made available to, and may be initiated by the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf. Requests for an Expedited Appeal may be verbal or written. For verbal Expedited Appeals, call 0-000-000-0000. For written Expedited Appeals, fax 0-000-000-0000 or mail to UCD. 1. Expedited Internal Dental Necessity Appeals In these cases, UCD will make a decision no later than seventy-two (72) hours of receipt of an internal Expedited Appeal request that meets the criteria for Expedited Appeal. In any case where the internal Expedited Appeal process does not resolve a difference of opinion between UCD and the Member or the Provider acting on behalf of the Member, the Appeal may be elevated to an Expedited External Appeal. If an Expedited internal Dental Necessity Appeal does not meet the Expedited Appeal criteria or does not include the Provider attestation signature, the Appeal will follow the standard Appeal process and timeframe.
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Expedited Dental Necessity Appeal. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize the Member’s life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, the Member may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal is a request concerning an Admission, availability of care, continued stay, or health care service for a covered person who is requesting Emergency services or has received Emergency services, but has not been discharged from a facility. Expedited Appeals are not provided for review of services previously rendered. An Expedited Appeal shall be made available to, and may be initiated by the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf. Requests for an Expedited Appeal may be verbal or written. UCD will make a decision no later than seventy-two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Xxx 00000
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