958 CMR, § 3.401

Current through Register 1536, December 6, 2024
Section 3.401 - Expedited External Review
(1) An insured or the insured's authorized representative may request to have the request for review processed as an expedited external review.
(2) Each request for an expedited external review shall contain a certification, in writing, from a health care professional responsible for the treatment or proposed treatment that delay in the provision or continuation of health care services that are the subject of a final adverse determination, would pose a serious and immediate threat to the health of the insured.
(3) Upon receiving a properly executed certification that a serious and immediate threat to the insured exists, the Office of Patient Protection shall qualify such request as eligible for an expedited external review.
(4) The insured or insured's authorized representative may file a request for expedited external review concurrently with a request for expedited internal review.
(5) The external review agency shall issue a decision within 72 hours of receiving the request for expedited external review.

958 CMR, § 3.401

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