Expedited Resolution. An expedited review by the Contractor of a Contractor Adverse Benefit Determination.
Expedited Resolution i. If the appeal was heard first through the Contractor appeal process DHCS shall reach a decision within 3 working days from agency receipt of a hearing request for a denial of a service that meets the criteria for an expedited appeal process but was not resolved using the Contractor’s expedited appeal timeframes, or
ii. Was resolved wholly or partially adversely to the beneficiary using the Contractor’s expedited appeal timeframes.
iii. If the appeal was made directly to the State Fair Hearing process without accessing the Contractor’s appeal process, DHCS shall reach a decision as expeditiously as the beneficiary’s health condition requires, but no later than 3 working days from state receipt of a hearing request for a denial of a service that meets the criteria for an expedited resolution.
Expedited Resolution. An expedited review by the Contractor of a Contractor’s Adverse Benefit Determination within three (3) calendar days after the Contractor receives the request, which may extended by up to fourteen (14) days.
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:
a. The decision reached by the Contractor;
b. The date of decision;
c. For appeals not resolved wholly in favor of the enrollee, the right to request a State fair hearing and how to do so; and
d. The right to request to receive benefits while the hearing is pending and how to make the request, explaining that the enrollee may be held liable for the cost of those services if the hearing decision upholds the Contractor.
Expedited Resolution. If a Dispute arises because Equifax believes that Critical Service Levels are not being met or that such Dispute relates to (i) matters that materially and adversely impact its business operations or (ii) compliance with applicable laws, and either party initiates the dispute resolution provisions set forth in Articles 12 and 13 for such Dispute, the time period set forth in Section 12.01 shall be changed to twenty-four (24) hours and either party may elect to bypass the Services Oversight Committee as provided in Section 12.02 and refer the Dispute directly from the Account Executives to senior management as provided in Section 12.03, and the thirty (30) business day period in Section 12.03 shall be reduced to fifteen (15) days. Except as expressly modified by this Section 12.04, all other provisions of Articles 12 and 13 shall apply to a Dispute.
Expedited Resolution. Any dispute stated in this Agreement to be resolved pursuant to this Section 24.4 (“Expert Committee Dispute”) shall be resolved as follows:
Expedited Resolution. Each Party shall appoint one (1) Expert for the Expert Committee within [***] Calendar Days after the date of the Expert Resolution Notice under this Section 24.4. The two (2) Experts shall appoint the third Expert within [***] days after the date the second Expert has been appointed. If the first two (2) Experts are unable to mutually agree upon the third Expert within such [***] days, then the third Expert shall be an arbitrator appointed by JAMS, which arbitrator need not have the experience of an Expert. Once the Expert Committee has been selected, the Expert Committee shall conduct the arbitration as a “baseball” type of binding arbitration; accordingly, notwithstanding the rules of JAMS, each Party shall provide the Expert Committee and the other Party with a written report outlining its position. The report must clearly provide and identify the Party’s position with respect to the disputed matter, as may be modified by such Party in accordance with procedures established by the Expert Committee. The Expert Committee may fashion such detailed procedures as the Expert considers appropriate to implement this intent. After receiving both Parties’ reports, the Expert Committee shall select one Party’s proposed positions as their decision, and shall not have the authority to render any substantive decision other than to select the proposal submitted by either Vividion or Roche. The Expert Committee shall have no discretion or authority with respect to modifying the positions of the Parties. The Expert Committees decision shall be final and binding on the Parties (and shall be considered to be the decision of the Parties on the matter for the purposes of resolving such dispute) and may be enforced in any court of competent jurisdiction.
Expedited Resolution. If a Dispute arises (a) prior to the Production Phase or (b) at any time if Rxxxx believes that Service Levels are not being met or that such Dispute relates to (i) matters that materially and adversely impact either party’s business operations or (ii) compliance with applicable laws, and either party initiates the dispute resolution provisions set forth in Article 12 for such Dispute, the time period set forth in Section 12.01 shall be changed to twenty-four (24) hours in Section 12.03. In such event, either party may elect to bypass the Services Oversight Committee as provided in Section 12.02 and refer the Dispute directly from the Account Executives to senior management as provided in Section 12.03, and the fourteen (14) day and five (5) day periods in Section 12.03 shall be reduced to seven (7) and three (3) days, respectively. Except as expressly modified by this Section 12.04, all other provisions of Articles 12 and 13 shall apply to a Dispute.
Expedited Resolution. The time periods set forth in Clause 14.1.2 and 14.1.3 shall be each reduced to five (5) Business Days, where this is requested by a Party and is reasonably required given the urgency and severity of the matter concerned.
