State Hearing Process. The MCO must develop and implement written policies and procedures that ensure the MCO's compliance with the state hearing provisions pursuant to division 5101:6 of the Administrative Code. The MCO must submit its state hearing policies and procedures for review and approval by ODM upon ODM's request. When the MCO is notified by the Bureau of State Hearings that a member has requested a state hearing, the MCO must review the state hearing request and within two business days of receipt of the Bureau of State Hearings notice, confirm via email to Xxxxx_Xxxxxxxx_Xxxxxxxxxx@xxx.xxxx.xxx one of the following: The MCO has no record that the member has requested an MCO appeal pertaining to the state hearing request. In this event, the MCO must attempt to contact the member to initiate the MCO appeal process unless the timeframe for a member to file an appeal with the MCO has been exhausted in accordance with OAC rule5160-26- 08.4. The MCO made an adverse appeal resolution pertaining to the state hearing request, whether or not the appeal was expedited, and attach a copy of the State Hearing Notice issued to the member. The MCO made a decision to authorize the services pertaining to the state hearing request and identify the date the member and provider were notified of the authorization. The MCO has not yet made a decision on the appeal request pertaining to the state hearing request, identify the date the MCO received the appeal request, and identify the date the MCO must currently issue a timely appeal resolution.
Appears in 4 contracts
Samples: Baseline Provider Agreement, Baseline Provider Agreement, Baseline Provider Agreement
