Level I Appeal Process Clause Samples

Level I Appeal Process. The Level I Appeal process involves either “standard review” or “expedited review.” Your Appeal will be eligible for an expedited review if your Appeal involves services that, if delayed, could seriously jeopardize your health or your ability to regain maximum function. We will grant an expedited review of any Appeal for services concerning (1) an Inpatient admission, (2) availability of care, or (3) continued health care or services for a Member who has received Medical Emergency services and has not been discharged from the Hospital where Medical Emergency services were provided. You should work with your Provider to request an expedited Appeal. A verbal request for an expedited Appeal can be made by calling Community Health Options Medical Management. If your Level I Appeal involves a medical determination, the appeal reviewer will be a Clinical Peer a. Standard Review (Non-Expedited Appeals) Timing and Notification. For standard Appeals, we are able to make decisions in most cases within 30 days after we receive the Appeal request. If you do not provide all of the information we need to decide the Appeal, we will let you know as soon as possible.