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

Timeframes for Expedited Appeal Resolution and Notification. (A) The Contractor shall complete each expedited Appeal and provide a Notice of Appeal Resolution to affected parties as expeditiously as the Enrollee’s health condition requires, but no later than 72 hours after the Contractor receives the expedited Appeal request. (B) The Contractor may extend the timeframe for completing the Appeal and providing notice by up to 14 calendar days if: (1) the Aggrieved Person requests the extension; or (2) the Contractor shows (to the satisfaction of the Department, upon its request) that there is need for additional information and how the delay is in the Aggrieved Person’s interest. (C) If the Contractor extends the timeframe and the extension was not requested by the Aggrieved Person, the Contractor shall: (1) make reasonable efforts to give the Aggrieved Person prompt oral notice of the delay; (2) give the Aggrieved Person written notice within two calendar days of the reason for the decision to extend the timeframe and inform the Aggrieved Person of the right to file a Grievance about the decision; and (3) complete the Appeal as expeditiously as the Enrollee’s health condition requires and no later than the date the extension expires.