Expedited Resolution of Appeals Sample Clauses

Expedited Resolution of Appeals. (1) The CONTRACTOR shall establish and utilize a process for the Expedited Resolution of Appeals when the CONTRACTOR determines that taking the time for a standard resolution could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function. Such a determination is based on: (a) a request from a Member; (b) a provider’s support of the Member’s request; (c) a provider’s request on behalf of the Member; or (d) the CONTRACTOR’s independent determination. (2) The CONTRACTOR shall ensure that the Expedited Review process is convenient and efficient for the Member. (3) The CONTRACTOR shall resolve the appeal within three (3) business days of receipt of the request for an Expedited Resolution of an Appeal, if the request meets the definition of an Expedited Resolution of an Appeal. In addition to written resolution notice, the CONTRACTOR shall also make reasonable efforts to provide and document oral notice. (4) The CONTRACTOR may extend the timeframe by up to fourteen (14) calendar days if the Member requests the extension, or the CONTRACTOR demonstrates to HSD that there is need for additional information, and the extension is in the Member’s best interests. For any extension not requested by the Member, the CONTRACTOR shall make reasonable efforts to give the Member prompt verbal notification and follow-up with a written notice within two (2) business days. (5) The CONTRACTOR shall ensure that punitive action is not taken against a Member or a provider who requests an Expedited Resolution or a provider who requests or supports a Member’s request for an Expedited Resolution. (6) The CONTRACTOR shall provide Expedited Resolution of an Appeal, if it meets expedited criteria, in response to an oral or written request from the Member or provider on behalf of a Member. (7) The CONTRACTOR shall inform the Member of the limited time available to present evidence and allegations in fact or law. (8) If the CONTRACTOR denies a request for an Expedited Resolution of an Appeal, it shall: (a) transfer the Appeal to the thirty (30)-day timeframe for standard resolution, in which the thirty (30)-day period begins on the date the CONTRACTOR received the request; (b) make reasonable efforts to give the Member prompt oral notice of the denial, and follow-up with a written notice within two (2) business days; and (c) inform the Member in the written notice of the right to file an Appeal if the Member is dissatisfied with the CONTRAC...

Expedited Resolution of Appeals. The CONTRACTOR shall establish and maintain an expedited review process for Appeals in accordance with 42 C.F.R. § 438.410. The CONTRACTOR shall ensure that the expedited review process is convenient and efficient for the Member. The CONTRACTOR shall resolve the expedited Appeal within seventy-two (72) hours of CONTRACTOR’s receipt of the appeal, per 42 C.F.R. § 438.408(b)(3) and (d)(2). The CONTRACTOR may extend the time frame for an expedited Appeal in accordance with 42 C.F.R. § 438.408(c). For any extension not requested by the Member, the CONTRACTOR shall make reasonable efforts to give the Member prompt oral notice of delay and within two (2) Calendar Days give the Member a written notice of the reason for the decision to extend the time frame and inform the Member of the right to file a grievance if the Member disagrees with the decision to extend the time frame. If the CONTRACTOR denies a request for expedited resolution of an Appeal, the CONTRACTOR shall transfer the Appeal to the time frame for standard resolution and make reasonable efforts to give the Member prompt oral notice of the denial and follow up within two (2) Calendar Days with a written notice. The CONTRACTOR shall inform the Member of the limited time available for expedited reviews to present evidence and allegations in fact or law. The CONTRACTOR shall document in writing all oral requests for expedited resolution and shall maintain the documentation in the case file. The CONTRACTOR must ensure that punitive action is not taken against a Provider who requests an expedited Appeal or supports a Member’s Appeal.

Expedited Resolution of Appeals. General Rule The Contractor must establish and maintain an expedited review process for appeals, when the Contractor determines (for a request from the member) or the provider indicates (in making the request on the member's behalf or supporting the member's request) that taking the time for a standard resolution could seriously jeopardize the member's life or health or ability to attain, maintain, or regain maximum function.

Expedited Resolution of Appeals. For expedited resolution of an appeal and notice to affected parties, the timeframe is established as three (3) business days after the Contractor receives the appeal. This timeframe may be extended under §9.7.2 of this section.

Expedited Resolution of Appeals. General Rule. The Contractor must establish and maintain an expedited review process for Appeals, when the Contractor determines (for a request from the Medicaid MCO Member) or the Provider indicates (in making the request on the Medicaid MCO Member's behalf or supporting the Medicaid MCO Member's request) that taking the time for a standard resolution could seriously jeopardize the member's life or health or ability to attain, maintain, or regain maximum function.

Expedited Resolution of Appeals. Contractor must establish and maintain an expedited review process for appeals, when Contractor determines (for a request from a member) or the provider indicates (in making the request on the member’s behalf or supporting the member’s request) that taking time for a standard resolution could seriously jeopardize the member’s life or health or ability to attain, maintain, or regain maximum function. The contractor must inform the member of the limited time available for the member to present evidence and allegations of fact or law, in person and in writing, in the case of an expedited resolution. Contractor must resolve a request for expedited appeal and notify affected parties of the resolution within three (3) working days after Contractor receives the request. Contractor may extend the timeframe by up to fourteen (14) calendar days, if the member requests the extension, or Contractor can show (to the satisfaction of the State, upon the State’s request) that there is need for additional information and how the delay is in the member’s interest. Contractor must ensure that punitive action is not taken against a provider who requests an expedited resolution or who supports a member’s request. If Contractor denies a request for expedited resolution of an appeal, it must transfer the appeal to the timeframe for standard resolution in accordance with Grievance and Appeals Process for

Expedited Resolution of Appeals. 1. The SE shall establish and maintain an Expedited Review process for Appeals when the SE determines that taking the time for a standard resolution could seriously jeopardize the member’s life or health or ability to attain, maintain, or regain maximum function or the child or youth is in the custody or supervision of CYFD and the SE has denied authorization for court-ordered out-of-home treatment. Such a determination is based on: a. A request from a consumer; b. A provider’s support of the consumer’s request; c. A provider’s request on behalf of the consumer; or d. The SE’s independent determination. 2. The SE shall ensure that the Expedited Review process is convenient and efficient for the consumer. 3. The SE shall resolve the appeal within three (3) business days of receipt of the request for an Expedited Appeal, if the request meets the definition of an Expedited Appeal. In addition to written resolution notice, the SE shall also make reasonable efforts to provide and document oral notice. 4. The SE may extend the timeframe by up to fourteen (14) calendar days if the consumer requests the extension, or the SE demonstrates that there is need for additional information, and the extension is in the consumer’s best interests. For any extension not requested by the consumer, the SE shall make reasonable efforts to give the consumer prompt verbal notification and follow-up with a written notice within two (2) business days. 5. The SE shall ensure that punitive action is not taken against a consumer or a provider who requests an Expedited Resolution or a provider who requests an Expedited Resolution or supports a consumer’s Expedited Appeal. 6. The SE shall provide Expedited Resolution of an Appeal, if it meets expedited criteria, in response to an oral or written request from the consumer or provider on behalf of a consumer. 7. The SE shall inform the consumer of the limited time available to present evidence and allegations in fact or law. 8. If the SE denies a request for an Expedited Resolution of an Appeal, it shall: a. Transfer the Appeal to the thirty (30) day timeframe for standard resolution, in which the thirty (30) day period begins on the date the SE received the request; b. Make reasonable efforts to give the consumer prompt oral notice of the denial, and follow-up with a written notice within two (2) business days; and c. Inform the consumer in the written notice of the right to file an Appeal if the consumer is dissatisfied with the SE’s dec...

Expedited Resolution of Appeals. For expedited resolution of an appeal and notice to affected parties, no longer than 72 hours after the PAHP receives the appeal. This timeframe may be extended under paragraph (c) of this section.

Expedited Resolution of Appeals. An expedited resolution of an appeal is an expedited review by the CONTRACTOR of a CONTRACTOR action.

Expedited Resolution of Appeals. An expedited resolution of an appeal is an expedited review by the Contractor of a Contractor action. A. The Contractor shall establish and maintain an expedited review process for appeals when the Contractor determines that allowing the time for a standard resolution could seriously jeopardize the Member’s life or health or ability to attain, maintain, or regain maximum function. Such a determination is based on: (1) a request from the Member; (2) a provider’s support of the Member’s request; (3) a provider’s request on behalf of the Member; or (4) the Contractor’s independent determination. The Contractor shall ensure that the expedited review process is convenient and efficient for the Member. B. The Contractor shall resolve the appeal within three working days of receipt of the request for an expedited appeal. In addition to written resolution notice, the Contractor shall also make reasonable efforts to provide and document oral notice. C. The Contractor may extend the timeframe by up to fourteen (14) calendar days if the Member requests the extension, or the Contractor demonstrates to the Department that there is need for additional information and the extension is in the Member’s interest. For any extension not requested by the Member, the Contractor shall give the Member written notice of the reason for the delay.