Section 1810.203.5 - Appeal"Appeal" means:
(a) A request by a beneficiary or a beneficiary's representative for review of an action as defined in Section 1810.200;(b) A request by a beneficiary or a beneficiary's representative for review of a provider's determination to deny or modify a beneficiary's request for a covered specialty mental health service;(c) A request by a beneficiary or a beneficiary's representative for review of the timeliness of the delivery of a specialty mental health service when the beneficiary believes that services are not being delivered in time to meet the beneficiary's needs, whether or not the mental health plan has established a timeliness standard for the delivery of the service.(d) A request by an MHP and/or MHP subcontractor for review of client record review findings that resulted in the disallowance of paid claims.Cal. Code Regs. Tit. 9, § 1810.203.5
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. New subsection (d) and amendment of NOTE filed 7-7-2010; operative 8-6-2010 (Register 2010, No. 28). Note: Authority: Section 14680, Welfare and Institutions Code. Reference: Sections 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Part 438, Subpart F.
1. New section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
2. New subsection (d) and amendment of Note filed 7-7-2010; operative 8-6-2010 (Register 2010, No. 28).