Common use of Time Frame for Expedited Appeal Resolution and Notification Clause in Contracts

Time Frame for Expedited Appeal Resolution and Notification. (A) The Contractor shall resolve each expedited Appeal and provide notice to affected parties as expeditiously as the Enrollee’s health condition requires, but no later than three working days after the Contractor receives the expedited Appeal request. (B) The Contractor may extend the time frame for resolving the Appeal and providing notice by up to 14 calendar days if: (1) the Enrollee requests the extension; or (2) the Contractor shows that there is need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (C) If the Contractor extends the timeframe and the extension was not requested by the Enrollee the Contractor shall give the Enrollee written notice of the reason for the delay.

Time Frame for Expedited Appeal Resolution and Notification. (A) The Contractor shall resolve each expedited Appeal and provide notice to affected parties as expeditiously as the Enrollee’s health condition requires, but no later than three working days after the Contractor receives the expedited Appeal request. (B) The Contractor may extend the time frame for resolving the Appeal and providing notice by up to 14 calendar days if: (1) the Enrollee Aggrieved Party requests the extension; or (2) the Contractor shows that there is need for additional information and how the delay is in the Enrollee’s interest (upon Department request). (C) If the Contractor extends the timeframe and the extension was not requested by the Enrollee Aggrieved Party the Contractor shall give the Enrollee Aggrieved Party written notice of the reason for the delay.