958 CMR, § 3.305

Current through Register 1533, October 25, 2024
Section 3.305 - Time Limits for Resolution of Non-expedited Internal Grievances
(1) A carrier or utilization review organization shall provide the insured or the insured's authorized representative, if any, with a written resolution of a grievance within 30 days of receipt of the oral or written grievance.
(2) When a grievance requires the review of medical records, the 30-day period will not begin to run until the insured or the insured's authorized representative submits a signed authorization for release of medical records and treatment information as required in 958 CMR 3.302(2). In the event that the signed authorization is not provided by the insured or the insured's authorized representative, if any, within 30 days of the receipt of the grievance, the carrier or utilization review organization may, in its discretion, issue a resolution of the grievance without review of some or all of the medical records.
(3) The time limits in 958 CMR 3.305 may be waived or extended by mutual written agreement of the insured or the insured's authorized representative and the carrier. Any such agreement shall state the additional time limits, which shall not exceed 30 days from the date of the agreement.

958 CMR, § 3.305

Amended by Mass Register Issue 1494, eff. 4/28/2023.